Healthcare Provider Details

I. General information

NPI: 1225189418
Provider Name (Legal Business Name): JOHN J KOWNACKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 FLETCHER PKWY STE 202
EL CAJON CA
92020-2500
US

IV. Provider business mailing address

13484 CALAIS DR
DEL MAR CA
92014-3524
US

V. Phone/Fax

Practice location:
  • Phone: 619-440-2022
  • Fax: 619-440-2466
Mailing address:
  • Phone: 858-794-1505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberG84672
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: