Provider Demographics
NPI:1982138665
Name:FORSLUND, JOHAN MARTIN (MD)
Entity Type:Individual
Prefix:
First Name:JOHAN
Middle Name:MARTIN
Last Name:FORSLUND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2141 N HARBOR BLVD STE 35000
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-3831
Mailing Address - Country:US
Mailing Address - Phone:714-626-8630
Mailing Address - Fax:
Practice Address - Street 1:2141 N HARBOR BLVD STE 35000
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3831
Practice Address - Country:US
Practice Address - Phone:714-626-8630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-19
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA160765207X00000X, 207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery