Provider Demographics
NPI:1851384499
Name:TSAKONAS, JOHN S (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:S
Last Name:TSAKONAS
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 1:16542 VENTURA BLVD STE 402
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-4562
Mailing Address - Country:US
Mailing Address - Phone:818-782-5041
Mailing Address - Fax:818-205-9091
Practice Address - Street 1:16542 VENTURA BLVD
Practice Address - Street 2:SUITE 402
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2005
Practice Address - Country:US
Practice Address - Phone:818-782-5041
Practice Address - Fax:818-205-9091
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG62791207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G627910Medicaid
CAWG62791NMedicare PIN
CAWG62791EMedicare PIN
CAWG62791KMedicare PIN
CAWG62791DMedicare PIN
CAB94303Medicare UPIN
CAWG62791CMedicare PIN
CAWG62791JMedicare PIN
CA00G627910Medicaid
CAWG62791IMedicare PIN
CAHW13403AMedicare PIN
CAHW13403Medicare PIN