Provider Demographics
NPI:1225005663
Name:PULLEN, JO ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:JO
Middle Name:ANN
Last Name:PULLEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JO
Other - Middle Name:ANN
Other - Last Name:PULLEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1711 W TEMPLE ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-5421
Mailing Address - Country:US
Mailing Address - Phone:213-207-5000
Mailing Address - Fax:213-273-8391
Practice Address - Street 1:1711 W TEMPLE ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-5421
Practice Address - Country:US
Practice Address - Phone:213-207-5000
Practice Address - Fax:213-273-8391
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG54941207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G549410Medicaid
CABP0233673OtherDEA NUMBER
CABP0233673OtherDEA NUMBER
CAF71894Medicare UPIN