Healthcare Provider Details

I. General information

NPI: 1952407561
Provider Name (Legal Business Name): JOHN JAHAN, MD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 07/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6655 ALVARADO RD
SAN DIEGO CA
92120-5208
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: 619-659-0246
Mailing address:
  • Phone: 619-445-1755
  • Fax: 619-659-0246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberA52263
License Number StateCA

VIII. Authorized Official

Name: JOHN JAHAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 619-445-1755