MEDICARE: DR. DILSHAD M. KHERAJ D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	20A9100	CA

General Provider Information

NPI Number	:	1467558163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DILSHAD M. KHERAJ D.O.

Provider Business Mailing Address
First Line	:	591 MCCRAY ST
Second Line	:	SUITE 221
City	:	HOLLISTER
State	:	CA
Zip	:	95023-2224
Country	:	US
Telephone Number	:	831-638-9715
Fax Number	:	831-637-7691

Provider Business Practice Location Address
First Line	:	591 MCCRAY ST
Second Line	:	SUITE 221
City	:	HOLLISTER
State	:	CA
Zip	:	95023-2224
Country	:	US
Telephone Number	:	831-638-9715
Fax Number	:	831-637-7691

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	09/29/2022

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