1578206538 NPI number — MR. KODY DHALIWAL M.D

Table of content: MR. KODY DHALIWAL M.D (NPI 1578206538)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578206538 NPI number — MR. KODY DHALIWAL M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DHALIWAL
Provider First Name:
KODY
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.D
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578206538
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
01/13/2023
NPI Reactivation Date:
01/24/2023

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
TRIDENT MEDICAL CENTER GME
Provider Second Line Business Mailing Address:
9225 UNIVERSITY BLVD SUITE E2A
Provider Business Mailing Address City Name:
NORTH CHARLESTON
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29406
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-847-5625
Provider Business Mailing Address Fax Number:
843-847-3424

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
TRIDENT MEDICAL CENTER
Provider Second Line Business Practice Location Address:
9330 MEDICAL PLAZA DRIVE
Provider Business Practice Location Address City Name:
NORTH CHARLESTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-797-7000
Provider Business Practice Location Address Fax Number:
843-847-3424
Provider Enumeration Date:
04/18/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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