Provider Demographics
NPI:1861475683
Name:DOLKAR, DECHEN (MD)
Entity type:Individual
Prefix:DR
First Name:DECHEN
Middle Name:
Last Name:DOLKAR
Suffix:
Gender:F
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:PO BOX 512185
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-0185
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2151 N HARBOR BLVD
Practice Address - Street 2:SUITE 1500
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3820
Practice Address - Country:US
Practice Address - Phone:714-446-5632
Practice Address - Fax:714-992-3081
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA549462085R0001X, 2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A549460Medicaid
CAG98133Medicare UPIN
CAWA54946IMedicare PIN
CA00A549460Medicaid
CA920006995Medicare PIN
CAWA54946DMedicare PIN
CAWA54946GMedicare PIN
CAWA54946KMedicare PIN