Healthcare Provider Details

I. General information

NPI: 1275451783
Provider Name (Legal Business Name): GAGANDEEP DHALIWAL MD, MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: GAGAN DHALIWAL MD, MBA

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 HOWARD ST STE 600
SAN FRANCISCO CA
94105-2674
US

IV. Provider business mailing address

405 HOWARD ST STE 600
SAN FRANCISCO CA
94105-2674
US

V. Phone/Fax

Practice location:
  • Phone: 415-264-8830
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number344204
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC210109
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: