Provider Demographics
NPI:1437126588
Name:BUCHANAN, JOHN KYLE (PT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:KYLE
Last Name:BUCHANAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12431 MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92841-3321
Mailing Address - Country:US
Mailing Address - Phone:949-462-0560
Mailing Address - Fax:
Practice Address - Street 1:24902 MOULTON PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92637-6410
Practice Address - Country:US
Practice Address - Phone:949-462-0560
Practice Address - Fax:949-462-3910
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2017-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT8447225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADE3952OtherMEDICARE RAILROAD GROUP #
CA1982635322OtherGROUP NPI #
CAP00289937OtherMEDICARE RAILROAD IND. #
CAW15225OtherMEDICARE PTAN #
CA1982635322OtherGROUP NPI #
CAWPT8447DMedicare ID - Type Unspecified