Healthcare Provider Details

I. General information

NPI: 1942245758
Provider Name (Legal Business Name): JOHANNES CZERNIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 02/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10833 LE CONTE AVE
LOS ANGELES CA
90095-3075
US

IV. Provider business mailing address

5767 W. CENTURY BLVD
LOS ANGELES CA
90045-5655
US

V. Phone/Fax

Practice location:
  • Phone: 310-301-6800
  • Fax:
Mailing address:
  • Phone: 310-301-6800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License NumberA56351
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2471N0900X
TaxonomyNuclear Medicine Technology Radiologic Technologist
License NumberA56351
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: