Healthcare Provider Details

I. General information

NPI: 1407085301
Provider Name (Legal Business Name): KALWANT S. DHILLON- GENERAL PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2009
Last Update Date: 07/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4425 W ASHLAN AVE STE 106
FRESNO CA
93722-7017
US

IV. Provider business mailing address

4425 W ASHLAN AVE STE 106
FRESNO CA
93722-7017
US

V. Phone/Fax

Practice location:
  • Phone: 559-271-0231
  • Fax: 559-271-0232
Mailing address:
  • Phone: 559-271-0231
  • Fax: 559-271-0232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberA305820
License Number StateCA

VIII. Authorized Official

Name: DR. KALWANT S DHILLON
Title or Position: GENERAL PRACTICE/ DOCTOR
Credential: MD
Phone: 559-271-0231