1417907940 NPI number — LPCH MEDICAL GROUP DIV OF LUCILE

Table of content: DR. JOHN WILLIAM DEASON III PHARMD (NPI 1922359025)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417907940 NPI number — LPCH MEDICAL GROUP DIV OF LUCILE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LPCH MEDICAL GROUP DIV OF LUCILE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417907940
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/12/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4700 BOHANNON DR
Provider Second Line Business Mailing Address:
MC 5530
Provider Business Mailing Address City Name:
MENLO PARK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94025-1031
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
725 WELCH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALO ALTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94304-1601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-498-6762
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HAERING
Authorized Official First Name:
DANA
Authorized Official Middle Name:
JEAN
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
650-721-2222

Provider Taxonomy Codes

  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282NC2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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