Healthcare Provider Details

I. General information

NPI: 1356395800
Provider Name (Legal Business Name): TEJWANT SINGH DHILLON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 03/28/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 S SCHWARTZ AVE STE 202
FARMINGTON NM
87401-5925
US

IV. Provider business mailing address

1313 E HERNDON AVE STE 203
FRESNO CA
93720-3306
US

V. Phone/Fax

Practice location:
  • Phone: 505-609-6770
  • Fax:
Mailing address:
  • Phone: 559-439-6808
  • Fax: 559-439-9335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number74248
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA94192
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number74248
License Number StateWI
# 4
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD2022-0624
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: