Healthcare Provider Details

I. General information

NPI: 1326006941
Provider Name (Legal Business Name): JOHN JAHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 04/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2999 HEALTH CENTER DR
SAN DIEGO CA
92123-2762
US

IV. Provider business mailing address

PO BOX 2811
LA MESA CA
91943-2811
US

V. Phone/Fax

Practice location:
  • Phone: 619-445-1755
  • Fax: 619-445-1755
Mailing address:
  • Phone: 619-445-1755
  • Fax: 619-445-1755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberA052263
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: