Provider Demographics
NPI:1205067758
Name:MA, JOHN K (MD, PHD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:K
Last Name:MA
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 SW 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66606-1535
Mailing Address - Country:US
Mailing Address - Phone:785-354-5300
Mailing Address - Fax:
Practice Address - Street 1:1414 SW 8TH AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-1535
Practice Address - Country:US
Practice Address - Phone:785-354-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-31
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04 379902085R0001X
KS04-379902085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS110357015Medicare PIN
KS201110800BMedicaid
KS201110800AMedicaid
KS110357015Medicare PIN