Healthcare Provider Details

I. General information

NPI: 1649212770
Provider Name (Legal Business Name): JOHN D ZIPPERER JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOHN DOUGLAS ESTES M.D.

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 04/17/2023
Certification Date: 04/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 S SEPULVEDA BLVD STE 402
LOS ANGELES CA
90049-3537
US

IV. Provider business mailing address

520 S SEPULVEDA BLVD STE 402
LOS ANGELES CA
90049-3537
US

V. Phone/Fax

Practice location:
  • Phone: 424-330-2838
  • Fax: 424-330-2838
Mailing address:
  • Phone: 424-330-2838
  • Fax: 424-330-2838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number6922
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number6922
License Number StateAK
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC145502
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: