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NPI Code Detail

MEDICARE: DR. JOHN DENNIS MULL MD MPH

MEDICARE: DR. JOHN DENNIS MULL MD MPH
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
1207Q00000XFamily Medicine PhysicianG019001CA

General Provider Information

NPI Number : 1962553651
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHN DENNIS MULL MD MPH
Provider Business Mailing Address
First Line : 6 WHITMAN COURT
Second Line :
City : IRVINE
State : CA
Zip : 92617-4056
Country : US
Telephone Number : 949-509-7507
Fax Number :
Provider Business Practice Location Address
First Line : 4425 SOUTH CENTRAL AVE
Second Line : SOUTH CENTRAL FAMILY HEALTH CENTER
City : LOS ANGELES
State : CA
Zip : 90011-3629
Country : US
Telephone Number : 323-908-4219
Fax Number : 323-908-4262
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/16/2007
Last Update Date : 07/08/2007

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