Provider Demographics
NPI:1841690765
Name:DHOOT, KANWARJOT
Entity type:Individual
Prefix:
First Name:KANWARJOT
Middle Name:
Last Name:DHOOT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KANWAR
Other - Middle Name:
Other - Last Name:DHOOT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:757 ALLACANTE DR
Mailing Address - Street 2:
Mailing Address - City:CERES
Mailing Address - State:CA
Mailing Address - Zip Code:95307-7307
Mailing Address - Country:US
Mailing Address - Phone:209-499-1647
Mailing Address - Fax:
Practice Address - Street 1:3900 SISK RD
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-3215
Practice Address - Country:US
Practice Address - Phone:209-545-3325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-27
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA70895183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist