Healthcare Provider Details

I. General information

NPI: 1184038572
Provider Name (Legal Business Name): KANWALDEEP MANN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KANWALDEEP DHILLON M.D.

II. Dates (important events)

Enumeration Date: 06/13/2014
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17036 S HARLAN RD STE 107
LATHROP CA
95330-8739
US

IV. Provider business mailing address

17036 S HARLAN RD STE 107
LATHROP CA
95330-8739
US

V. Phone/Fax

Practice location:
  • Phone: 949-805-0668
  • Fax: 949-805-0668
Mailing address:
  • Phone: 949-805-0668
  • Fax: 949-805-0668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA155565
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number30733
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: