Provider Demographics
NPI:1528378460
Name:GILLEAN, JOHN ALEXANDER (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALEXANDER
Last Name:GILLEAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JACK
Other - Middle Name:
Other - Last Name:GILLEAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:55 SANTA CLARA AVE STE 171
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-1333
Mailing Address - Country:US
Mailing Address - Phone:510-541-2323
Mailing Address - Fax:510-907-7966
Practice Address - Street 1:55 SANTA CLARA AVE STE 171
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-1333
Practice Address - Country:US
Practice Address - Phone:510-541-2323
Practice Address - Fax:510-907-7966
Is Sole Proprietor?:No
Enumeration Date:2010-10-13
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.00543482084P0800X
CAA1416572084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry