Provider Demographics
NPI:1467558163
Name:KHERAJ, DILSHAD M (DO)
Entity Type:Individual
Prefix:DR
First Name:DILSHAD
Middle Name:M
Last Name:KHERAJ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:591 MCCRAY ST
Mailing Address - Street 2:SUITE 221
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-2224
Mailing Address - Country:US
Mailing Address - Phone:831-638-9715
Mailing Address - Fax:831-637-7691
Practice Address - Street 1:591 MCCRAY ST
Practice Address - Street 2:SUITE 221
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-2224
Practice Address - Country:US
Practice Address - Phone:831-638-9715
Practice Address - Fax:831-637-7691
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A9100207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI62771Medicare UPIN
CA020A91000Medicare PIN
CABJ113YMedicare PIN