Provider Demographics
NPI:1053997098
Name:MAZLOOM, KIRAN KAUR
Entity type:Individual
Prefix:
First Name:KIRAN
Middle Name:KAUR
Last Name:MAZLOOM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 CARSON DR
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94086-5953
Mailing Address - Country:US
Mailing Address - Phone:408-205-8457
Mailing Address - Fax:
Practice Address - Street 1:3020 CHILDRENS WAY # MC5065
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4223
Practice Address - Country:US
Practice Address - Phone:858-966-5863
Practice Address - Fax:858-966-5409
Is Sole Proprietor?:No
Enumeration Date:2021-03-21
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program