Provider Demographics
NPI:1407085301
Name:KALWANT S. DHILLON- GENERAL PRACTICE
Entity Type:Organization
Organization Name:KALWANT S. DHILLON- GENERAL PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PRACTICE/ DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KALWANT
Authorized Official - Middle Name:S
Authorized Official - Last Name:DHILLON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-271-0231
Mailing Address - Street 1:4425 W ASHLAN AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-7017
Mailing Address - Country:US
Mailing Address - Phone:559-271-0231
Mailing Address - Fax:559-271-0232
Practice Address - Street 1:4425 W ASHLAN AVE STE 106
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-7017
Practice Address - Country:US
Practice Address - Phone:559-271-0231
Practice Address - Fax:559-271-0232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-13
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA305820261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A305820Medicare PIN