Provider Demographics
NPI:1831133321
Name:EINCK, JOHN P (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:EINCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 710488
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92171-0488
Mailing Address - Country:US
Mailing Address - Phone:619-326-0700
Mailing Address - Fax:619-326-0703
Practice Address - Street 1:751 MEDICAL CENTER CT
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-6617
Practice Address - Country:US
Practice Address - Phone:619-482-5851
Practice Address - Fax:619-482-5865
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG81776174400000X, 2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG81776OtherMEDICAL LICENSE
CA00G817760Medicaid
CAWG81776CMedicare ID - Type UnspecifiedSCV MEDICARE
CAWG81776AMedicare PIN
CAWG81776BMedicare PIN
CAWG81776DMedicare PIN
CAG81776OtherMEDICAL LICENSE
CAG19548Medicare UPIN