Provider Demographics
NPI:1902801764
Name:DARIN, JOHN JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JOSEPH
Last Name:DARIN
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 1:696 HAMPSHIRE RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-2699
Mailing Address - Country:US
Mailing Address - Phone:818-933-6902
Mailing Address - Fax:
Practice Address - Street 1:696 HAMPSHIRE RD
Practice Address - Street 2:SUITE 120
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-2699
Practice Address - Country:US
Practice Address - Phone:818-933-6902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC29520174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC29520Medicare ID - Type UnspecifiedMC
CAA33947Medicare UPIN