Healthcare Provider Details

I. General information

NPI: 1619165842
Provider Name (Legal Business Name): JEDEDIAH DIXON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2007
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DEPT VETERANS AFFAIRS 11201 BENTON STREET
LOMA LINDA CA
92357-1000
US

IV. Provider business mailing address

5753 E SANTA ANA CANYON RD STE G BOX 457
ANAHEIM CA
92807-3296
US

V. Phone/Fax

Practice location:
  • Phone: 909-825-7084
  • Fax:
Mailing address:
  • Phone: 714-392-0556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberA109534
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number57-013185
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: