Provider Demographics
NPI:1225138936
Name:LOPEZ, JANUARY KIM (MD)
Entity Type:Individual
Prefix:
First Name:JANUARY
Middle Name:KIM
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JANUARY
Other - Middle Name:KIM
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:ONE HOAG DRIVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-4162
Mailing Address - Country:US
Mailing Address - Phone:949-645-3534
Mailing Address - Fax:
Practice Address - Street 1:DEPT LA 21555
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91185-1555
Practice Address - Country:US
Practice Address - Phone:949-236-8620
Practice Address - Fax:866-823-8444
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA920952085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A920950OtherBS
CA00A920950Medicaid
CABX448XMedicare PIN
CA00A920950Medicaid
CABX448ZMedicare PIN