Healthcare Provider Details

I. General information

NPI: 1619662202
Provider Name (Legal Business Name): KARANVIR GILL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5271 N OLINDA AVE
FRESNO CA
93723-7669
US

IV. Provider business mailing address

5271 N OLINDA AVE
FRESNO CA
93723-7669
US

V. Phone/Fax

Practice location:
  • Phone: 559-285-8809
  • Fax:
Mailing address:
  • Phone: 559-285-8809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1619662202
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: