Provider Demographics
NPI:1205247558
Name:JAN, JOANNA MAGDALENA (MD)
Entity type:Individual
Prefix:DR
First Name:JOANNA
Middle Name:MAGDALENA
Last Name:JAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JOANNA
Other - Middle Name:MAGDALENA
Other - Last Name:SKORA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2701 OLYMPIC BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-4183
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2701 OLYMPIC BLVD
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-4183
Practice Address - Country:US
Practice Address - Phone:855-268-2822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-08
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD468778207R00000X
PAMT206150207R00000X
CAA149769207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine