Healthcare Provider Details

I. General information

NPI: 1780996132
Provider Name (Legal Business Name): BIDUR DHAKAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2010
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11234 ANDERSON ST STE 1519
LOMA LINDA CA
92350-1716
US

IV. Provider business mailing address

11234 ANDERSON ST STE 1519
LOMA LINDA CA
92350-1716
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-4884
  • Fax:
Mailing address:
  • Phone: 909-558-4884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC169889
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number051201
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number51722
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: