Healthcare Provider Details

I. General information

NPI: 1578206538
Provider Name (Legal Business Name): KODY DHALIWAL M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2022
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date: 01/13/2023
Reactivation Date: 01/24/2023

III. Provider practice location address

TRIDENT MEDICAL CENTER 9330 MEDICAL PLAZA DRIVE
NORTH CHARLESTON SC
29406
US

IV. Provider business mailing address

538 SOUND DR
SUMMERVILLE SC
29486-2932
US

V. Phone/Fax

Practice location:
  • Phone: 843-797-7000
  • Fax: 843-847-3424
Mailing address:
  • Phone: 360-661-8082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number88509
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: