Healthcare Provider Details

I. General information

NPI: 1386862308
Provider Name (Legal Business Name): JOHN K JONES MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 11/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3580 EAST IMPERIAL HIGHWAY
LYNWOOD CA
90262
US

IV. Provider business mailing address

3580 EAST IMPERIAL HIGHWAY
LYNWOOD CA
90262
US

V. Phone/Fax

Practice location:
  • Phone: 310-763-3075
  • Fax:
Mailing address:
  • Phone: 310-763-3075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VH0002X
TaxonomyHospice and Palliative Medicine (Obstetrics & Gynecology) Physician
License NumberA051154
License Number StateCA

VIII. Authorized Official

Name: DR. JOHN K JONES
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-763-3075