Healthcare Provider Details

I. General information

NPI: 1801232731
Provider Name (Legal Business Name): DON JOHN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2013
Last Update Date: 07/01/2020
Certification Date: 07/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18321 CLARK ST
TARZANA CA
91356-3501
US

IV. Provider business mailing address

3701 WILSHIRE BLVD STE 600
LOS ANGELES CA
90010-2814
US

V. Phone/Fax

Practice location:
  • Phone: 818-881-0800
  • Fax:
Mailing address:
  • Phone: 323-361-3550
  • Fax: 323-361-8052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA156442
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: