Provider Demographics
NPI:1326134115
Name:DHAMI, KANWER S (MD)
Entity Type:Individual
Prefix:
First Name:KANWER
Middle Name:S
Last Name:DHAMI
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 1:2570 JENSEN AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:SANGER
Mailing Address - State:CA
Mailing Address - Zip Code:93657-2269
Mailing Address - Country:US
Mailing Address - Phone:559-875-7149
Mailing Address - Fax:559-875-9661
Practice Address - Street 1:2570 JENSEN AVE STE 103
Practice Address - Street 2:
Practice Address - City:SANGER
Practice Address - State:CA
Practice Address - Zip Code:93657-2269
Practice Address - Country:US
Practice Address - Phone:559-875-7149
Practice Address - Fax:559-875-9661
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64661207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A646610Medicaid
CA00A646611Medicare PIN
CAG91823Medicare UPIN