Provider Demographics
NPI:1669490454
Name:DHILLON, GURINDER S (MD)
Entity Type:Individual
Prefix:
First Name:GURINDER
Middle Name:S
Last Name:DHILLON
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 1:1261 TRAVIS BLVD
Mailing Address - Street 2:STE 320
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-4897
Mailing Address - Country:US
Mailing Address - Phone:707-423-2506
Mailing Address - Fax:707-425-4236
Practice Address - Street 1:1261 TRAVIS BLVD
Practice Address - Street 2:STE 320
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-4897
Practice Address - Country:US
Practice Address - Phone:707-423-2506
Practice Address - Fax:707-425-4236
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA49131207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
Y03705Medicare UPIN
00A491312Medicare PIN