Basic Information
| Provider Information | |||||||||
| NPI: | 1063587616 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THIARA | ||||||||
| FirstName: | ARVINDER | ||||||||
| MiddleName: | KAUR | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | KAUR | ||||||||
| OtherFirstName: | ARVINDER | ||||||||
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| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 600 COFFEE RD | ||||||||
| Address2: | |||||||||
| City: | MODESTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953554201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095241211 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1300 W LODI AVE | ||||||||
| Address2: | SUITE P | ||||||||
| City: | LODI | ||||||||
| State: | CA | ||||||||
| PostalCode: | 952423000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2093661990 | ||||||||
| FaxNumber: | 2094739256 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2006 | ||||||||
| LastUpdateDate: | 10/22/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | A97774 | CA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.