Provider Demographics
NPI:1154455806
Name:MAHAL, KANWAR TEJINDER PAUL SINGH (MD)
Entity type:Individual
Prefix:DR
First Name:KANWAR
Middle Name:TEJINDER PAUL SINGH
Last Name:MAHAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:7710 N FRESNO ST # 102
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2403
Mailing Address - Country:US
Mailing Address - Phone:559-437-9100
Mailing Address - Fax:559-437-9111
Practice Address - Street 1:7710 N FRESNO ST # 102
Practice Address - Street 2:#102
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2403
Practice Address - Country:US
Practice Address - Phone:559-437-9100
Practice Address - Fax:559-437-9111
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA88928207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABZ039ZMedicaid
CAOOA889280Medicare PIN