Provider Demographics
NPI:1417017492
Name:KAISER, JOHN EMIL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:EMIL
Last Name:KAISER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1820 FULLERTON AVE
Mailing Address - Street 2:#120
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-3160
Mailing Address - Country:US
Mailing Address - Phone:951-371-4400
Mailing Address - Fax:951-273-0719
Practice Address - Street 1:1820 FULLERTON AVE
Practice Address - Street 2:#120
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-3160
Practice Address - Country:US
Practice Address - Phone:951-371-4400
Practice Address - Fax:951-273-0719
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2008-09-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG246932086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G246930Medicaid
CA00G246930Medicaid
CA00G246930Medicare ID - Type Unspecified