Healthcare Provider Details

I. General information

NPI: 1083344584
Provider Name (Legal Business Name): DANIEL JOHN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2022
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 BRUCE ST
YREKA CA
96097-3450
US

IV. Provider business mailing address

444 BRUCE ST
YREKA CA
96097-3450
US

V. Phone/Fax

Practice location:
  • Phone: 530-842-3507
  • Fax: 530-841-2050
Mailing address:
  • Phone: 530-842-4121
  • Fax: 530-841-2050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA200222
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: