Provider Demographics
NPI:1982796439
Name:LUSTER, JOHN B (MD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:B
Last Name:LUSTER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2617 E CHAPMAN AVE
Mailing Address - Street 2:#306
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869
Mailing Address - Country:US
Mailing Address - Phone:714-997-1920
Mailing Address - Fax:714-744-9864
Practice Address - Street 1:2617 E CHAPMAN AVE
Practice Address - Street 2:#306
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92869
Practice Address - Country:US
Practice Address - Phone:714-997-1920
Practice Address - Fax:714-744-9864
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG46508207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA330019993OtherTAX
CA00G465080Medicaid
A50406Medicare UPIN