Provider Demographics
NPI:1790945970
Name:JOHN R GORNY MD INC
Entity Type:Organization
Organization Name:JOHN R GORNY MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:GORNY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-661-3101
Mailing Address - Street 1:665 CAMINO DE LOS MARES
Mailing Address - Street 2:203A
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-2859
Mailing Address - Country:US
Mailing Address - Phone:949-661-3101
Mailing Address - Fax:949-661-2865
Practice Address - Street 1:665 CAMINO DE LOS MARES
Practice Address - Street 2:203A
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-2859
Practice Address - Country:US
Practice Address - Phone:949-661-3101
Practice Address - Fax:949-661-2865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG12635207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G126350Medicaid
CA00G126350Medicaid
CAA90216Medicare UPIN
CAG12635Medicare PIN