MEDICARE: DR. JOANNA MAGDALENA JAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MD468778	PA
2	207R00000X	Internal Medicine Physician	MT206150	PA
3	207R00000X	Internal Medicine Physician	A149769	CA

General Provider Information

NPI Number	:	1205247558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOANNA MAGDALENA JAN M.D.

Provider Business Mailing Address
First Line	:	2701 OLYMPIC BLVD
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90404-4183
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2701 OLYMPIC BLVD
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90404-4183
Country	:	US
Telephone Number	:	855-268-2822
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2014
Last Update Date	:	12/06/2021

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