Provider Demographics
NPI:1801915830
Name:DHANOA, TEGINDER SINGH (MD)
Entity type:Individual
Prefix:DR
First Name:TEGINDER
Middle Name:SINGH
Last Name:DHANOA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JIM
Other - Middle Name:
Other - Last Name:DHANOA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1450 TREAT BLVD
Mailing Address - Street 2:STE 300
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-2168
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2400 BALFOUR RD
Practice Address - Street 2:STE 120
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-4956
Practice Address - Country:US
Practice Address - Phone:925-308-8111
Practice Address - Fax:925-308-8712
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA94646207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ18646ZOtherMEDICARE GROUP NUMBER
00BD748X0Medicare PIN