Provider Demographics
NPI:1164611570
Name:GILL, KISHWAR R (MD)
Entity Type:Individual
Prefix:
First Name:KISHWAR
Middle Name:R
Last Name:GILL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KISHWAR
Other - Middle Name:R
Other - Last Name:SOOFI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5943 W ELOWIN DR
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-9222
Mailing Address - Country:US
Mailing Address - Phone:559-622-9601
Mailing Address - Fax:559-627-1131
Practice Address - Street 1:468 N VERMONT AVE
Practice Address - Street 2:
Practice Address - City:DINUBA
Practice Address - State:CA
Practice Address - Zip Code:93618-1631
Practice Address - Country:US
Practice Address - Phone:559-591-6200
Practice Address - Fax:559-591-2724
Is Sole Proprietor?:No
Enumeration Date:2007-10-22
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A526972207Q00000X
CAA52697207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA03434Medicare UPIN
CAZZZ31922ZMedicare PIN