Provider Demographics
NPI:1821023540
Name:DHAWAN, KAMLESH TANEJA (MD)
Entity Type:Individual
Prefix:
First Name:KAMLESH
Middle Name:TANEJA
Last Name:DHAWAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3420 W BEVERLY BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-1539
Mailing Address - Country:US
Mailing Address - Phone:323-887-1950
Mailing Address - Fax:323-887-4932
Practice Address - Street 1:3420 W BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-1539
Practice Address - Country:US
Practice Address - Phone:323-887-1950
Practice Address - Fax:323-887-4932
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38701207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A387010OtherMEDICAL PPIN #
CA00A387010OtherMEDICAL PPIN #
CAWA38701CMedicare PIN