Healthcare Provider Details

I. General information

NPI: 1194720722
Provider Name (Legal Business Name): UROLOGY ASSOCIATES OF CENTRAL CALIFORNIA MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 07/19/2024
Certification Date: 07/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7014 N WHITNEY AVE
FRESNO CA
93720-0155
US

IV. Provider business mailing address

7014 N WHITNEY AVE STE A
FRESNO CA
93720-0155
US

V. Phone/Fax

Practice location:
  • Phone: 559-321-2800
  • Fax: 559-321-2780
Mailing address:
  • Phone: 559-321-2800
  • Fax: 559-321-2780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberFNP21026
License Number StateCA

VIII. Authorized Official

Name: DR. KULDIP JBS BEHNIWAL
Title or Position: AUTHORIZED OFFICIAL
Credential: M.D.
Phone: 559-321-2803