Provider Demographics
NPI:1619011095
Name:JON W CHURNIN MD INC
Entity Type:Organization
Organization Name:JON W CHURNIN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:W
Authorized Official - Last Name:CHURNIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-343-9746
Mailing Address - Street 1:219 ELM ST APT 5
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-2640
Mailing Address - Country:US
Mailing Address - Phone:650-343-9746
Mailing Address - Fax:
Practice Address - Street 1:901 CAMPUS DR STE 102
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-4930
Practice Address - Country:US
Practice Address - Phone:650-991-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-18
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG34291207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G342910Medicare ID - Type UnspecifiedPROVIDER NUMBER