=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821166588
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOHM J REGAN, M. D., INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/01/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 120 S SPALDING DR STE 400
-----------------------------------------------------
City | BEVERLY HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90212-1842
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-440-3235
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 120 S. SPALDING DR. #400
-----------------------------------------------------
City | BEVERLY HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90212
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-440-3235
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | GLORIA QUEVEDO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 310-385-8012
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | G85966
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------