# JOHN P MCKENZIE III M D INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1316982762
- **Authorized official:** DR. JOHN PAUL MCKENZIE III M.D. (PHYSICIAN)
- **Authorized official phone:** (818) 502-9420

## Contact information

- **Practice address:** 660 W BROADWAY, GLENDALE, CA 91204-1008
- **Practice address phone:** (818) 502-9420
- **Practice address fax:** (818) 243-9605
- **Mailing address:** 1510 S CENTRAL AVE, SUITE 150, GLENDALE, CA 91204-2500
- **Mailing address phone:** (818) 247-0346

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RC0000X | Cardiovascular Disease Physician | G71752 | CA | — |
| 207RC0001X | Clinical Cardiac Electrophysiology Physician | G71752 | CA | Yes |

## Other

- **Enumeration date:** 06/19/2006
- **Last updated:** 06/30/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00G717520 | — | CA |