Healthcare Provider Details

I. General information

NPI: 1437569670
Provider Name (Legal Business Name): JUAN JOSE VIZCAINO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2014
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2316 E MEYER BLVD
KANSAS CITY MO
64132-1136
US

IV. Provider business mailing address

14293 W 131ST ST
OLATHE KS
66062-6234
US

V. Phone/Fax

Practice location:
  • Phone: 816-912-2100
  • Fax:
Mailing address:
  • Phone: 913-990-9511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2018026867
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number30380
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2018026867
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: