Provider Demographics
NPI:1134142078
Name:JOHN MUIR PHYSICIAN NETWORK
Entity type:Organization
Organization Name:JOHN MUIR PHYSICIAN NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT PRACTICE ADM
Authorized Official - Prefix:
Authorized Official - First Name:M
Authorized Official - Middle Name:KATHERINE
Authorized Official - Last Name:SORENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-952-2888
Mailing Address - Street 1:PO BOX 102858
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91189-0139
Mailing Address - Country:US
Mailing Address - Phone:925-952-2828
Mailing Address - Fax:925-952-2850
Practice Address - Street 1:2305 CAMINO RAMON
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1396
Practice Address - Country:US
Practice Address - Phone:925-837-1886
Practice Address - Fax:925-837-3913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0068751Medicaid
CACD4001Medicare PIN
CAZZZ47768ZMedicare PIN
CACH0335Medicare PIN
CAGR0068751Medicaid
CACD2399Medicare PIN
CACD4000Medicare PIN
CACI4093Medicare PIN