Provider Demographics
NPI:1043027451
Name:KANG, JAGBIR KAUR
Entity type:Individual
Prefix:
First Name:JAGBIR
Middle Name:KAUR
Last Name:KANG
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 1:1093 KRAFTILE RD
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-7617
Mailing Address - Country:US
Mailing Address - Phone:510-766-1418
Mailing Address - Fax:
Practice Address - Street 1:1093 KRAFTILE RD
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-7617
Practice Address - Country:US
Practice Address - Phone:510-766-1418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist