Provider Demographics
NPI:1255207031
Name:JE BOHM PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:JE BOHM PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOHM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-476-2073
Mailing Address - Street 1:14742 NEWPORT AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-6177
Mailing Address - Country:US
Mailing Address - Phone:714-476-2073
Mailing Address - Fax:951-537-6931
Practice Address - Street 1:5315 E TISBURY CT
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-4626
Practice Address - Country:US
Practice Address - Phone:714-476-2073
Practice Address - Fax:951-537-6931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-16
Last Update Date:2025-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty