Healthcare Provider Details

I. General information

NPI: 1164777132
Provider Name (Legal Business Name): JOHN R HAIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2012
Last Update Date: 07/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38042 PALO COLORADO RD
CARMEL CA
93923-8155
US

IV. Provider business mailing address

38042 PALO COLORADO RD
CARMEL CA
93923-8155
US

V. Phone/Fax

Practice location:
  • Phone: 831-277-1573
  • Fax: 831-620-1489
Mailing address:
  • Phone: 831-277-1573
  • Fax: 831-620-1489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZF0201X
TaxonomyForensic Pathology Physician
License NumberG63545
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: