Healthcare Provider Details

I. General information

NPI: 1467558734
Provider Name (Legal Business Name): JOHN BARKODAR M.D. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 01/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3314 FIRESTONE BLVD
SOUTH GATE CA
90280
US

IV. Provider business mailing address

3314 FIRESTONE BLVD
SOUTH GATE CA
90280
US

V. Phone/Fax

Practice location:
  • Phone: 323-567-4483
  • Fax: 323-567-2647
Mailing address:
  • Phone: 323-567-4483
  • Fax: 323-567-2647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0A44541
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberOA44541
License Number StateCA

VIII. Authorized Official

Name: JOHN BARKODAR
Title or Position: PRESIDENT
Credential: MD
Phone: 323-567-4483