Provider Demographics
NPI:1104922806
Name:DHAWAN, VINOD K (MD)
Entity type:Individual
Prefix:
First Name:VINOD
Middle Name:K
Last Name:DHAWAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:19122 BECHARD AVENUE
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703
Mailing Address - Country:US
Mailing Address - Phone:909-865-5023
Mailing Address - Fax:562-865-0393
Practice Address - Street 1:1902 ROYALTY DR
Practice Address - Street 2:SUITE 200
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767
Practice Address - Country:US
Practice Address - Phone:909-865-5023
Practice Address - Fax:562-865-0393
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34165207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A341650Medicaid
CAA27401Medicare UPIN
CA00A341650Medicaid