Basic Information
| Provider Information | |||||||||
| NPI: | 1477732899 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GURINDER S. DHILLON M D PROFESSIONAL CORPORATION | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1525 WEBSTER ST STE A | ||||||||
| Address2: | |||||||||
| City: | FAIRFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945334935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074232510 | ||||||||
| FaxNumber: | 7074254236 | ||||||||
| Practice Location | |||||||||
| Address1: | 1525 WEBSTER ST STE A | ||||||||
| Address2: | |||||||||
| City: | FAIRFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945334935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074232506 | ||||||||
| FaxNumber: | 7074291158 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2007 | ||||||||
| LastUpdateDate: | 12/03/2012 | ||||||||
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| AuthorizedOfficialLastName: | DHILLON | ||||||||
| AuthorizedOfficialFirstName: | GURINDER | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7074232510 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | A49131 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.