Healthcare Provider Details

I. General information

NPI: 1467611988
Provider Name (Legal Business Name): JOHN CHRISTOPHER KURYLO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2008
Last Update Date: 11/05/2021
Certification Date: 11/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2826 HARRIS ST
EUREKA CA
95503-4809
US

IV. Provider business mailing address

200 W CENTER STREET PROMENADE STE 300
ANAHEIM CA
92805-3960
US

V. Phone/Fax

Practice location:
  • Phone: 707-443-8066
  • Fax: 707-268-3251
Mailing address:
  • Phone: 714-449-4841
  • Fax: 714-937-6233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number237510
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA142617
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: