Provider Demographics
NPI:1447588306
Name:JUNO MEDICAL GROUP
Entity Type:Organization
Organization Name:JUNO MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:UYANNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-299-3412
Mailing Address - Street 1:6741 VAN NUYS BLVD
Mailing Address - Street 2:SUITE 203K
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-4630
Mailing Address - Country:US
Mailing Address - Phone:818-299-3412
Mailing Address - Fax:818-988-9804
Practice Address - Street 1:6741 VAN NUYS BLVD
Practice Address - Street 2:SUITE 203K
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-4630
Practice Address - Country:US
Practice Address - Phone:818-299-3412
Practice Address - Fax:818-988-9804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-03
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70516207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty