Healthcare Provider Details

I. General information

NPI: 1104066232
Provider Name (Legal Business Name): KANWAR T MAHAL, MD INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2009
Last Update Date: 03/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7710 N FRESNO ST # 102
FRESNO CA
93720-2403
US

IV. Provider business mailing address

7710 N FRESNO ST # 102
FRESNO CA
93720-2403
US

V. Phone/Fax

Practice location:
  • Phone: 559-437-9100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA88928
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License NumberA88928
License Number StateCA

VIII. Authorized Official

Name: DR. KANWAR T MAHAL
Title or Position: PRESIDENT
Credential:
Phone: 559-437-9100