Provider Demographics
NPI:1326018987
Name:DHAWAN, SUNIL S (MD)
Entity Type:Individual
Prefix:MR
First Name:SUNIL
Middle Name:S
Last Name:DHAWAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2557 MOWRY AVE
Mailing Address - Street 2:STE 34
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538
Mailing Address - Country:US
Mailing Address - Phone:510-797-4111
Mailing Address - Fax:510-797-3320
Practice Address - Street 1:2557 MOWRY AVE
Practice Address - Street 2:STE 34
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538
Practice Address - Country:US
Practice Address - Phone:510-797-4111
Practice Address - Fax:510-797-3320
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG53340207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABF280ZOtherMEDICARE PTAN
CACB367OtherMEDICARE PTAN
CABF280ZOtherMEDICARE PTAN