Provider Demographics
NPI:1982823027
Name:DHAH, MANJIT S (PA ,NP)
Entity Type:Individual
Prefix:MR
First Name:MANJIT
Middle Name:S
Last Name:DHAH
Suffix:
Gender:M
Credentials:PA ,NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1479 W LACEY BLVD
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-5906
Mailing Address - Country:US
Mailing Address - Phone:559-583-4617
Mailing Address - Fax:559-583-4625
Practice Address - Street 1:1455 PARK BLVD
Practice Address - Street 2:
Practice Address - City:ORANGE COVE
Practice Address - State:CA
Practice Address - Zip Code:93646-9322
Practice Address - Country:US
Practice Address - Phone:559-626-0882
Practice Address - Fax:559-626-0882
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15574363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant