=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326172685
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN EDWARD JANIKOWSKI DO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/16/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | BLDG 603 OCEAN ROAD A.P.O. A.P. 96555
-----------------------------------------------------
City | A.P.O.
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 96555
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-355-2223
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1702 A.P.O. A.P. 96555
-----------------------------------------------------
City | A.P.O.
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 96555
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-355-2223
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 1064
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 2OA 5168
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------