MEDICARE: KALWANT S. DHILLON, M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM2500X	Medical Specialty Clinic/Center	A305820	CA

General Provider Information

NPI Number	:	1851463830
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KALWANT S. DHILLON, M.D.

Provider Business Mailing Address
First Line	:	6079 N FRESNO ST STE 101
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93710-5276
Country	:	US
Telephone Number	:	559-438-0292
Fax Number	:	559-438-0294

Provider Business Practice Location Address
First Line	:	6079 N FRESNO ST STE 101
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93710-5276
Country	:	US
Telephone Number	:	559-438-0292
Fax Number	:	559-438-0294

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. DESIREE M HERNANDEZ
Credential	:
Telephone Number	:	559-438-0292

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	02/08/2008

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