Healthcare Provider Details

I. General information

NPI: 1316009103
Provider Name (Legal Business Name): JOHN ALEXANDER IRVINE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 S FAIR OAKS AVE SUITE 280
PASADENA CA
91105-2613
US

IV. Provider business mailing address

5767 W CENTURY BLVD STE 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 626-817-4747
  • Fax: 626-817-4702
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberG59884
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: