MEDICARE: DR. JOHN SPILLANE BURNS 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	207Q00000X	Family Medicine Physician	A41985	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407921737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN SPILLANE BURNS M.D.

Provider Business Mailing Address
First Line	:	22030 MARJORIE AVE
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90503-6939
Country	:	US
Telephone Number	:	310-408-8316
Fax Number	:

Provider Business Practice Location Address
First Line	:	2252 BEVERLY BLVD STE 103
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-2246
Country	:	US
Telephone Number	:	213-674-7424
Fax Number	:	213-674-7524

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

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	01/09/2024

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