Healthcare Provider Details

I. General information

NPI: 1932642691
Provider Name (Legal Business Name): JOHN PAE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JOHN PAE PMHNP

II. Dates (important events)

Enumeration Date: 11/29/2016
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3619 N MISSION RD
LINCOLN HEIGHTS CA
90031-3136
US

IV. Provider business mailing address

3619 N MISSION RD
LINCOLN HEIGHTS CA
90031-3136
US

V. Phone/Fax

Practice location:
  • Phone: 213-271-0100
  • Fax:
Mailing address:
  • Phone: 213-271-0100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95035307
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: