Healthcare Provider Details

I. General information

NPI: 1861787673
Provider Name (Legal Business Name): JOHN CHRISTIAN LAYKE DO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2011
Last Update Date: 06/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 N BEDFORD DR SUITE 308
BEVERLY HILLS CA
90210-4310
US

IV. Provider business mailing address

436 N BEDFORD DR SUITE 308
BEVERLY HILLS CA
90210-4310
US

V. Phone/Fax

Practice location:
  • Phone: 310-275-6600
  • Fax: 310-275-6607
Mailing address:
  • Phone: 310-275-6600
  • Fax: 310-275-6607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number20A10771
License Number StateCA

VIII. Authorized Official

Name: JOHN CHRISTIAN LAYKE
Title or Position: CEO
Credential: DO
Phone: 310-275-6600