Provider Demographics
NPI:1679643126
Name:DE BEIXEDON, JOHN K F (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:K F
Last Name:DE BEIXEDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:675 S ARROYO PKWY
Mailing Address - Street 2:#320
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3263
Mailing Address - Country:US
Mailing Address - Phone:626-577-9495
Mailing Address - Fax:626-792-2117
Practice Address - Street 1:675 S ARROYO PKWY
Practice Address - Street 2:#320
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3263
Practice Address - Country:US
Practice Address - Phone:626-577-9495
Practice Address - Fax:626-792-2117
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA046593207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F57078Medicare UPIN
A46593Medicare ID - Type Unspecified