MEDICARE: DR. JOHN TED DJABRAYAN 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	A136184	CA

General Provider Information

NPI Number	:	1861805814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN TED DJABRAYAN M.D.

Provider Business Mailing Address
First Line	:	4711 W ASHLAN AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93722-4307
Country	:	US
Telephone Number	:	559-203-6660
Fax Number	:

Provider Business Practice Location Address
First Line	:	4711 W ASHLAN AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93722-4307
Country	:	US
Telephone Number	:	559-203-6660
Fax Number	:

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

Provider Enumeration Date	:	06/07/2014
Last Update Date	:	07/21/2022

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