MEDICARE: DR. DONALD J. GJESDAL 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	207K00000X	Allergy & Immunology Physician	G37094	CA

General Provider Information

NPI Number	:	1447254339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONALD J. GJESDAL M.D.

Provider Business Mailing Address
First Line	:	17021 YORBA LINDA BLVD
Second Line	:	STE 160
City	:	YORBA LINDA
State	:	CA
Zip	:	92886-3711
Country	:	US
Telephone Number	:	714-961-0110
Fax Number	:

Provider Business Practice Location Address
First Line	:	17021 YORBA LINDA BLVD
Second Line	:	STE 160
City	:	YORBA LINDA
State	:	CA
Zip	:	92886-3711
Country	:	US
Telephone Number	:	714-961-0110
Fax Number	:

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

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	07/08/2007

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