Provider Demographics
NPI:1912920109
Name:LAYKE, JOHN CHRISTIAN (DO)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:CHRISTIAN
Last Name:LAYKE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 N. BEDFORD DRIVE
Mailing Address - Street 2:SUITE 308
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4310
Mailing Address - Country:US
Mailing Address - Phone:310-275-6600
Mailing Address - Fax:310-275-6607
Practice Address - Street 1:436 N. BEDFORD DRIVE
Practice Address - Street 2:SUITE 308
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4310
Practice Address - Country:US
Practice Address - Phone:310-275-6600
Practice Address - Fax:310-275-6607
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A10771208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACE6372Medicare PIN