Provider Demographics
NPI:1033447305
Name:LUNDGREN, JOHN THORNTON (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:THORNTON
Last Name:LUNDGREN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9777 WILSHIRE BLVD.
Mailing Address - Street 2:SUITE 905
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212
Mailing Address - Country:US
Mailing Address - Phone:310-273-7495
Mailing Address - Fax:310-273-0714
Practice Address - Street 1:9777 WILSHIRE BLVD.
Practice Address - Street 2:SUITE 905
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212
Practice Address - Country:US
Practice Address - Phone:310-273-7495
Practice Address - Fax:310-273-0714
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-25
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA234592084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry