Healthcare Provider Details

I. General information

NPI: 1992074058
Provider Name (Legal Business Name): KANWALJIT GILL MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2011
Last Update Date: 10/27/2023
Certification Date: 10/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38656 MEDICAL CENTER DR STE A
PALMDALE CA
93551-4695
US

IV. Provider business mailing address

38656 MEDICAL CENTER DR STE A
PALMDALE CA
93551-4695
US

V. Phone/Fax

Practice location:
  • Phone: 661-940-4444
  • Fax: 661-940-4446
Mailing address:
  • Phone: 661-940-4444
  • Fax: 661-940-4446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA538000
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberA538000
License Number StateCA

VIII. Authorized Official

Name: DR. KANWALJIT S GILL
Title or Position: PRESIDENT
Credential: MD
Phone: 661-940-4444