Provider Demographics
NPI:1821155599
Name:JONATHAN H. WHEELER M.D., INC.
Entity Type:Organization
Organization Name:JONATHAN H. WHEELER M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-642-1363
Mailing Address - Street 1:351 HOSPITAL RD STE 611
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3508
Mailing Address - Country:US
Mailing Address - Phone:949-642-1363
Mailing Address - Fax:949-642-1438
Practice Address - Street 1:351 HOSPITAL RD
Practice Address - Street 2:SUITE 611
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3509
Practice Address - Country:US
Practice Address - Phone:949-642-1363
Practice Address - Fax:949-642-1438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG61174174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW17019Medicare PIN