Healthcare Provider Details

I. General information

NPI: 1306859046
Provider Name (Legal Business Name): VIJAY M DHAWAN M.D. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3420 W BEVERLY BLVD
MONTEBELLO CA
90640-1539
US

IV. Provider business mailing address

3420 WEST BEVERLY BLVD
MONTEBELLO CA
90640-1539
US

V. Phone/Fax

Practice location:
  • Phone: 213-700-0390
  • Fax:
Mailing address:
  • Phone: 213-700-0390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0000X
TaxonomyAdolescent Medicine (Internal Medicine) Physician
License Number20A8058
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberA32299
License Number StateCA

VIII. Authorized Official

Name: DR. VIJAY M DHAWAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 213-700-0390