Basic Information
| Provider Information | |||||||||
| NPI: | 1851571764 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KAUSHAL | ||||||||
| FirstName: | POONAM | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 38000 CAMDEN ST | ||||||||
| Address2: | # 32 | ||||||||
| City: | FREMONT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945365169 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5103044141 | ||||||||
| FaxNumber: | 5702275460 | ||||||||
| Practice Location | |||||||||
| Address1: | 530 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | ORANGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928684525 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7145713682 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2007 | ||||||||
| LastUpdateDate: | 11/07/2007 | ||||||||
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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 | 1223G0001X | 56590 | CA | Y | Dental Providers | Dentist | General Practice |
No ID Information.