Basic Information
| Provider Information | |||||||||
| NPI: | 1346409067 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEHAL | ||||||||
| FirstName: | HIMDIP | ||||||||
| MiddleName: | KAUR | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3400 DATA DR | ||||||||
| Address2: | PHYSICIAN SUPPORT SERVICES | ||||||||
| City: | RANCHO CORDOVA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956707956 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 550 W RANCH VIEW DR | ||||||||
| Address2: | SUITE 3000 | ||||||||
| City: | ROCKLIN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 957655396 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164091400 | ||||||||
| FaxNumber: | 9164091499 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2008 | ||||||||
| LastUpdateDate: | 12/17/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | ML20008798 | WA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | 600355594 | WA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | ML20008798 | 01 | WA | MEDICAL LICENCE | OTHER | AL116989 | 01 | CA | MEDICAL LICENSE | OTHER |