Healthcare Provider Details

I. General information

NPI: 1083005607
Provider Name (Legal Business Name): JOHN DAWSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2015
Last Update Date: 02/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

973 E VILLA ST APT 6
PASADENA CA
91106-1082
US

IV. Provider business mailing address

973 E VILLA ST APT 6
PASADENA CA
91106-1082
US

V. Phone/Fax

Practice location:
  • Phone: 626-689-8131
  • Fax:
Mailing address:
  • Phone: 626-689-8131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number16231
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: