Provider Demographics
NPI:1346409067
Name:DEHAL, HIMDIP KAUR (MD)
Entity Type:Individual
Prefix:
First Name:HIMDIP
Middle Name:KAUR
Last Name:DEHAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:PHYSICIAN SUPPORT SERVICES
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:550 W RANCH VIEW DR
Practice Address - Street 2:SUITE 3000
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-5396
Practice Address - Country:US
Practice Address - Phone:916-409-1400
Practice Address - Fax:916-409-1499
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAML20008798390200000X
WA600355594207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAML20008798OtherMEDICAL LICENCE
CAAL116989OtherMEDICAL LICENSE