Healthcare Provider Details

I. General information

NPI: 1629343736
Provider Name (Legal Business Name): KEVIN DHOLARIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2012
Last Update Date: 02/03/2022
Certification Date: 02/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11480 BROOKSHIRE AVE STE 111
DOWNEY CA
90241-5021
US

IV. Provider business mailing address

11480 BROOKSHIRE AVE STE 111
DOWNEY CA
90241-5021
US

V. Phone/Fax

Practice location:
  • Phone: 562-904-4445
  • Fax: 562-904-4441
Mailing address:
  • Phone: 562-904-4445
  • Fax: 562-904-4441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA161629
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: