Healthcare Provider Details

I. General information

NPI: 1275991697
Provider Name (Legal Business Name): JOHN LARSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2016
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 VON KARMAN AVE STE 150
NEWPORT BEACH CA
92660-2087
US

IV. Provider business mailing address

4440 VON KARMAN AVE STE 150
NEWPORT BEACH CA
92660-2087
US

V. Phone/Fax

Practice location:
  • Phone: 949-688-7733
  • Fax: 949-688-7733
Mailing address:
  • Phone: 949-688-7733
  • Fax: 949-688-7733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number142514
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: