Provider Demographics
NPI:1023008679
Name:BIORKMAN, JON G (MD)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:G
Last Name:BIORKMAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:17360 BROOKHURST ST
Mailing Address - Street 2:ATTN: MCMF CREDENTIALING DEPT.
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-3720
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4050 BARRANCA PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-7706
Practice Address - Country:US
Practice Address - Phone:949-551-1090
Practice Address - Fax:949-262-5500
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2015-10-13
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Provider Licenses
StateLicense IDTaxonomies
CAA40965207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A409650Medicaid
CAEN735ZMedicare PIN
CA00A409650Medicaid
CAWA40965CMedicare PIN