Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | G59271 | CA |
NPI | 1043318199 |
---|---|
Provider Name | John S Videen |
First Address | La Jolla, CA 92037-8411 |
Second Address | Chula Vista, CA 91911-6658 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 29/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G592710 | (05) | CA |
A93532 | (02) | CA |
BD830S | SO. CALIFORNIA PTAN (01) | CA |
CA108496 | NO. CALIFORNIA PTAN (01) | CA |