Provider Demographics
NPI:1376791616
Name:WEST, JUSTIN ERIC (MD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:ERIC
Last Name:WEST
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Gender:M
Credentials:MD
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Mailing Address - Street 1:230 S MAIN ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3851
Mailing Address - Country:US
Mailing Address - Phone:714-978-2445
Mailing Address - Fax:714-978-2998
Practice Address - Street 1:230 S MAIN ST
Practice Address - Street 2:SUITE 210
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3851
Practice Address - Country:US
Practice Address - Phone:714-978-2445
Practice Address - Fax:714-978-2998
Is Sole Proprietor?:No
Enumeration Date:2008-08-28
Last Update Date:2017-05-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA1026882086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA400013138Medicare PIN