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NPI Code Detail

MEDICARE: JIRI KONECNY DO

MEDICARE: JIRI KONECNY DO
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
1208G00000XThoracic Surgery (Cardiothoracic Vascular Surgery) Physician20A7020CA

General Provider Information

NPI Number : 1861449373
Entity Type Code : Individual
Provider Name (Legal Business Name) : JIRI KONECNY DO
Provider Business Mailing Address
First Line : 3044 ATLANTIC AVE
Second Line :
City : LONG BEACH
State : CA
Zip : 90807
Country : US
Telephone Number : 562-595-8418
Fax Number : 562-595-8430
Provider Business Practice Location Address
First Line : 3044 ATLANTIC AVE
Second Line :
City : LONG BEACH
State : CA
Zip : 90807
Country : US
Telephone Number : 562-595-8418
Fax Number : 562-595-8430
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/28/2006
Last Update Date : 03/31/2020

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