MEDICARE: DAHLIN JACKSON DO

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	390200000X	Student in an Organized Health Care Education/Training Program		MN
2	2084P0804X	Child & Adolescent Psychiatry Physician	20A23927	CA

General Provider Information

NPI Number	:	1538804877
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAHLIN JACKSON DO

Provider Business Mailing Address
First Line	:	3020 CHILDRENS WAY
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-4223
Country	:	US
Telephone Number	:	858-576-1700
Fax Number	:

Provider Business Practice Location Address
First Line	:	3020 CHILDRENS WAY
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-4223
Country	:	US
Telephone Number	:	858-576-1700
Fax Number	:

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

Provider Enumeration Date	:	05/02/2022
Last Update Date	:	05/12/2026

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