Provider Demographics
NPI:1881663136
Name:GHAEL, DINESHCHANDRA (MD)
Entity Type:Individual
Prefix:DR
First Name:DINESHCHANDRA
Middle Name:
Last Name:GHAEL
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 1:11919 HESPERIA ROAD
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345
Mailing Address - Country:US
Mailing Address - Phone:760-948-1454
Mailing Address - Fax:760-948-1234
Practice Address - Street 1:11919 HESPERIA ROAD
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345
Practice Address - Country:US
Practice Address - Phone:760-948-1454
Practice Address - Fax:760-948-1234
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY201970-1208000000X
CAC52976208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01886722Medicaid
NY01886722Medicaid