Provider Demographics
NPI:1194965806
Name:DICKERSON KHOUZAM, LYNDA MARGARET (MD)
Entity type:Individual
Prefix:DR
First Name:LYNDA
Middle Name:MARGARET
Last Name:DICKERSON KHOUZAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1684 W SHAW AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-3517
Mailing Address - Country:US
Mailing Address - Phone:559-265-3098
Mailing Address - Fax:559-497-3882
Practice Address - Street 1:1684 W SHAW AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3517
Practice Address - Country:US
Practice Address - Phone:559-265-3098
Practice Address - Fax:559-497-3882
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-20
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG88143208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics