Provider Demographics
NPI:1285791806
Name:DHILLON, INDERJIT KAUR (MD)
Entity type:Individual
Prefix:DR
First Name:INDERJIT
Middle Name:KAUR
Last Name:DHILLON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5043 E. KINGS CANYON #101
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721-3962
Mailing Address - Country:US
Mailing Address - Phone:559-455-1500
Mailing Address - Fax:559-253-1302
Practice Address - Street 1:5043 E. KINGS CANYON #101
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-3962
Practice Address - Country:US
Practice Address - Phone:559-455-1500
Practice Address - Fax:559-253-1302
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38371208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA38371OtherMEDICAL LICENSE #
CA00A383711OtherMEDI-CAL PROVIDER #
CA00A383710OtherMEDI-CAL PROVIDER #