Healthcare Provider Details

I. General information

NPI: 1497335012
Provider Name (Legal Business Name): KAMINDARA DHILLON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2021
Last Update Date: 03/18/2024
Certification Date: 03/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 MERCY AVE STE 301
MERCED CA
95340-8367
US

IV. Provider business mailing address

315 MERCY AVE STE 301
MERCED CA
95340-8367
US

V. Phone/Fax

Practice location:
  • Phone: 209-564-3513
  • Fax:
Mailing address:
  • Phone: 209-564-3513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA191915
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: