Provider Demographics
NPI:1871685610
Name:PEPPARD, JOHN K (PHD IN PSYCHOLOGY)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:K
Last Name:PEPPARD
Suffix:
Gender:M
Credentials:PHD IN PSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:32 MOONSTONE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92602-1610
Mailing Address - Country:US
Mailing Address - Phone:714-734-3448
Mailing Address - Fax:714-734-3449
Practice Address - Street 1:23521 PASEO DE VALENCIA
Practice Address - Street 2:SUITE 304A THE TAJ MAHAL MEDICAL CENTER
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3107
Practice Address - Country:US
Practice Address - Phone:714-734-3448
Practice Address - Fax:714-734-3449
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14282103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
S39972Medicare UPIN
CACP14282Medicare ID - Type Unspecified
CABE735ZMedicare PIN