Provider Demographics
NPI:1295828291
Name:DINGILIAN, JOHN RICHARD (MD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:RICHARD
Last Name:DINGILIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 SYCAMORE DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-1500
Mailing Address - Country:US
Mailing Address - Phone:805-527-9140
Mailing Address - Fax:805-527-0783
Practice Address - Street 1:2750 SYCAMORE DR
Practice Address - Street 2:SUITE 202
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-1500
Practice Address - Country:US
Practice Address - Phone:805-527-9140
Practice Address - Fax:805-527-0783
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG75774207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0065680Medicaid
CAGR0065680Medicaid
CAWG75774BMedicare ID - Type Unspecified