Provider Demographics
NPI:1679703417
Name:LUNG ALLERGY AND SLEEP DISORDER CENTER INC
Entity Type:Organization
Organization Name:LUNG ALLERGY AND SLEEP DISORDER CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVINDER
Authorized Official - Middle Name:PS
Authorized Official - Last Name:DHILLON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-743-5428
Mailing Address - Street 1:1162 LIVE OAK BLVD
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-3407
Mailing Address - Country:US
Mailing Address - Phone:530-743-5428
Mailing Address - Fax:530-743-6091
Practice Address - Street 1:1162 LIVE OAK BLVD
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-3407
Practice Address - Country:US
Practice Address - Phone:530-743-5428
Practice Address - Fax:530-743-6091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-14
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA84144207R00000X
CAA73500207RC0200X
CAA104391207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1780773960Medicaid
CA1922016062Medicaid
CA1780773960Medicare PIN
CAH66308Medicare UPIN
CAH92810Medicare UPIN
CA1922016062Medicare PIN
CA1922016062Medicaid