Healthcare Provider Details

I. General information

NPI: 1255207031
Provider Name (Legal Business Name): JE BOHM PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2025
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5315 E TISBURY CT
ANAHEIM CA
92807-4626
US

IV. Provider business mailing address

14742 NEWPORT AVE STE 203
TUSTIN CA
92780-6177
US

V. Phone/Fax

Practice location:
  • Phone: 714-476-2073
  • Fax: 951-537-6931
Mailing address:
  • Phone: 714-476-2073
  • Fax: 951-537-6931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN BOHM
Title or Position: PRACTICE OWNER
Credential: MD
Phone: 714-476-2073