MEDICARE: JANUARY KIM LOPEZ MD

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	2085R0202X	Diagnostic Radiology Physician	A92095	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00A920950	OTHER	CA	BS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225138936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANUARY KIM LOPEZ MD

Provider Business Mailing Address
First Line	:	ONE HOAG DRIVE
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92663-4162
Country	:	US
Telephone Number	:	949-645-3534
Fax Number	:

Provider Business Practice Location Address
First Line	:	DEPT LA 21555
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91185-1555
Country	:	US
Telephone Number	:	949-236-8620
Fax Number	:	866-823-8444

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

Provider Enumeration Date	:	09/23/2006
Last Update Date	:	08/03/2010

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