Provider Demographics
NPI:1235019134
Name:RAI, PRABHDEEP KAUR
Entity type:Individual
Prefix:
First Name:PRABHDEEP
Middle Name:KAUR
Last Name:RAI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PRAB
Other - Middle Name:KAUR
Other - Last Name:RAI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:596 W MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:KINGSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:93631-2642
Mailing Address - Country:US
Mailing Address - Phone:559-473-5864
Mailing Address - Fax:
Practice Address - Street 1:631 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90014-2211
Practice Address - Country:US
Practice Address - Phone:213-395-8928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-03
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program