Healthcare Provider Details

I. General information

NPI: 1184623969
Provider Name (Legal Business Name): KULDEEP S GILL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 01/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 E HERNDON AVE SUITE 101
FRESNO CA
93720-3359
US

IV. Provider business mailing address

1660 E HERNDON AVE SUITE 101
FRESNO CA
93720-3359
US

V. Phone/Fax

Practice location:
  • Phone: 559-431-9753
  • Fax: 559-431-3478
Mailing address:
  • Phone: 559-431-9753
  • Fax: 559-431-3478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA820570
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA820570
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: