Basic Information
| Provider Information | |||||||||
| NPI: | 1639175581 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DHALIWAL | ||||||||
| FirstName: | NARINDER | ||||||||
| MiddleName: | SINGH | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 241011 | ||||||||
| Address2: | |||||||||
| City: | LODI | ||||||||
| State: | CA | ||||||||
| PostalCode: | 952419511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2093397435 | ||||||||
| FaxNumber: | 2093333054 | ||||||||
| Practice Location | |||||||||
| Address1: | 1901 W KETTLEMAN LN | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | LODI | ||||||||
| State: | CA | ||||||||
| PostalCode: | 952424337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2093348540 | ||||||||
| FaxNumber: | 2093682885 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2005 | ||||||||
| LastUpdateDate: | 12/11/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A451480 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | A045148 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | A45180 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | EFF: 1/13/2014 | 05 | CA | MEDICAID | P01284212/DS9933 | 01 | CA | RAILROAD MEDICARE | OTHER |