Provider Demographics
NPI:1407921737
Name:BURNS, JOHN SPILLANE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:SPILLANE
Last Name:BURNS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:22030 MARJORIE AVE
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-6939
Mailing Address - Country:US
Mailing Address - Phone:310-408-8316
Mailing Address - Fax:
Practice Address - Street 1:2252 BEVERLY BLVD STE 103
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-2246
Practice Address - Country:US
Practice Address - Phone:213-674-7424
Practice Address - Fax:213-674-7524
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA41985207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1447496468Medicaid