Provider Demographics
NPI:1487602819
Name:DHILLON, MANJIT SINGH (MD)
Entity type:Individual
Prefix:
First Name:MANJIT
Middle Name:SINGH
Last Name:DHILLON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4120 DALE RD
Mailing Address - Street 2:STE J8-266
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-9232
Mailing Address - Country:US
Mailing Address - Phone:209-522-6100
Mailing Address - Fax:209-522-6110
Practice Address - Street 1:700 17TH ST STE 102
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-1248
Practice Address - Country:US
Practice Address - Phone:209-488-3728
Practice Address - Fax:209-653-0585
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA89879207RC0200X, 207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI51348Medicare UPIN
CA00A898790Medicare ID - Type Unspecified