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NPI Code Detail

MEDICARE: MR. JOHN ANTHON OLSEN MD

MEDICARE: MR. JOHN ANTHON OLSEN 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
1208200000XPlastic Surgery PhysicianC34364CA

General Provider Information

NPI Number : 1740370766
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JOHN ANTHON OLSEN MD
Provider Business Mailing Address
First Line : 2080 CENTURY PARK EAST
Second Line : SUITE 610
City : LOS ANGELES
State : CA
Zip : 90067-2009
Country : US
Telephone Number : 310-552-9444
Fax Number : 310-552-1222
Provider Business Practice Location Address
First Line : 2080 CENTURY PARK EAST
Second Line : SUITE 610
City : LOS ANGELES
State : CA
Zip : 90067-2009
Country : US
Telephone Number : 310-552-9444
Fax Number : 310-552-1222
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2006
Last Update Date : 07/08/2007

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Directions to “ MR. JOHN ANTHON OLSEN MD” Practice Location

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