Provider Demographics
NPI:1578206538
Name:DHALIWAL, KODY (MD)
Entity Type:Individual
Prefix:MR
First Name:KODY
Middle Name:
Last Name:DHALIWAL
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:TRIDENT MEDICAL CENTER GME
Mailing Address - Street 2:9225 UNIVERSITY BLVD SUITE E2A
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406
Mailing Address - Country:US
Mailing Address - Phone:843-847-5625
Mailing Address - Fax:843-847-3424
Practice Address - Street 1:TRIDENT MEDICAL CENTER
Practice Address - Street 2:9330 MEDICAL PLAZA DRIVE
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406
Practice Address - Country:US
Practice Address - Phone:843-797-7000
Practice Address - Fax:843-847-3424
Is Sole Proprietor?:No
Enumeration Date:2022-04-18
Last Update Date:2023-01-24
Deactivation Date:2023-01-13
Deactivation Code:
Reactivation Date:2023-01-24
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program