Healthcare Provider Details

I. General information

NPI: 1972543296
Provider Name (Legal Business Name): JOHN J HEWETT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 REYNOLDS AVE STE 110
IRVINE CA
92614-5562
US

IV. Provider business mailing address

1400 REYNOLDS AVE STE 200
IRVINE CA
92614-5563
US

V. Phone/Fax

Practice location:
  • Phone: 949-387-4724
  • Fax: 949-209-0407
Mailing address:
  • Phone: 949-387-4724
  • Fax: 949-209-0407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberC52896
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: