Provider Demographics
NPI:1740370766
Name:OLSEN, JOHN ANTHON (MD)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ANTHON
Last Name:OLSEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2080 CENTURY PARK EAST
Mailing Address - Street 2:SUITE 610
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-2009
Mailing Address - Country:US
Mailing Address - Phone:310-552-9444
Mailing Address - Fax:310-552-1222
Practice Address - Street 1:2080 CENTURY PARK EAST
Practice Address - Street 2:SUITE 610
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2009
Practice Address - Country:US
Practice Address - Phone:310-552-9444
Practice Address - Fax:310-552-1222
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC34364208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
A87723Medicare UPIN