MEDICARE: DR. SURISHAM DHILLON M.D.

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	174400000X	Specialist	A51651	CA
2	225400000X	Rehabilitation Practitioner	A51651	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A51651	OTHER	CA	LICENSE NUMBER
2	6507231	OTHER	CA	MEDICAL

General Provider Information

NPI Number	:	1770652299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SURISHAM DHILLON M.D.

Provider Business Mailing Address
First Line	:	23928 LYONS AVE STE 102
Second Line	:
City	:	NEWHALL
State	:	CA
Zip	:	91321-2452
Country	:	US
Telephone Number	:	661-222-2326
Fax Number	:	661-222-9444

Provider Business Practice Location Address
First Line	:	23928 LYONS AVE STE 102
Second Line	:
City	:	NEWHALL
State	:	CA
Zip	:	91321-2452
Country	:	US
Telephone Number	:	661-222-2326
Fax Number	:	661-222-9444

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

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	03/07/2023

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Directions to “ DR. SURISHAM DHILLON M.D.” Practice Location

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