Healthcare Provider Details

I. General information

NPI: 1306039300
Provider Name (Legal Business Name): SHYAM DAHIYA MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2007
Last Update Date: 01/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650 SOUTH ST SUITE 412
LAKEWOOD CA
90712-1502
US

IV. Provider business mailing address

3650 SOUTH ST SUITE 412
LAKEWOOD CA
90712-1502
US

V. Phone/Fax

Practice location:
  • Phone: 562-602-1012
  • Fax: 562-602-1915
Mailing address:
  • Phone: 562-602-1012
  • Fax: 562-602-1915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: SHYAM DAHIYA
Title or Position: DIRECTOR
Credential: MD
Phone: 562-634-8001