Provider Demographics
NPI:1548209976
Name:DHAMIJA, KAILASH R I (MD)
Entity Type:Individual
Prefix:DR
First Name:KAILASH
Middle Name:R
Last Name:DHAMIJA
Suffix:I
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 1:18326 PIONEER BLVD
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90701-5533
Mailing Address - Country:US
Mailing Address - Phone:562-860-5599
Mailing Address - Fax:
Practice Address - Street 1:18326 PIONEER BLVD
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:CA
Practice Address - Zip Code:90701-5533
Practice Address - Country:US
Practice Address - Phone:562-860-5599
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42292174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A422922Medicaid
CA0A422920Medicaid
CAWA42292DMedicare ID - Type Unspecified
CA00A422922Medicaid
CA0A422920Medicaid