Provider Demographics
NPI:1578731428
Name:DHILLON, KALWANT S
Entity Type:Individual
Prefix:
First Name:KALWANT
Middle Name:S
Last Name:DHILLON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:559-438-0292
Mailing Address - Fax:559-438-0294
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:559-438-0292
Practice Address - Fax:559-438-0294
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-13
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA305820208600000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A305820Medicaid
CA00A305820Medicare PIN
CA00A305820Medicaid