Healthcare Provider Details

I. General information

NPI: 1487602819
Provider Name (Legal Business Name): MANJIT SINGH DHILLON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 17TH ST STE 102
MODESTO CA
95354-1248
US

IV. Provider business mailing address

4120 DALE RD STE J8-266
MODESTO CA
95356-9232
US

V. Phone/Fax

Practice location:
  • Phone: 209-488-3728
  • Fax: 209-653-0585
Mailing address:
  • Phone: 209-522-6100
  • Fax: 209-522-6110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number89879
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number89879
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number89879
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: