Healthcare Provider Details

I. General information

NPI: 1285791806
Provider Name (Legal Business Name): INDERJIT KAUR DHILLON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 09/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5043 E. KINGS CANYON #101
FRESNO CA
93721-3962
US

IV. Provider business mailing address

5043 E. KINGS CANYON #101
FRESNO CA
93721-3962
US

V. Phone/Fax

Practice location:
  • Phone: 559-455-1500
  • Fax: 559-253-1302
Mailing address:
  • Phone: 559-455-1500
  • Fax: 559-253-1302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA38371
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: