Healthcare Provider Details

I. General information

NPI: 1295231249
Provider Name (Legal Business Name): MANDIP SINGH KANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2018
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6733 N WILLOW AVE STE 107
FRESNO CA
93710-5953
US

IV. Provider business mailing address

7257 N FRESNO ST
FRESNO CA
93720-2950
US

V. Phone/Fax

Practice location:
  • Phone: 559-435-4700
  • Fax: 559-298-7951
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA173539
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberA173539
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: