Individual
JOHN S VIDEEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
752 MEDICAL CENTER CT, SUITE 302, CHULA VISTA, CA 91911-6658
(619) 421-3361
(619) 656-8936
Mailing address
4225 EXECUTIVE SQ STE 450, LA JOLLA, CA 92037-8411
(858) 810-0000
(858) 268-1911
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
G59271
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G592710
—
CA
01
—
BD830S
SO. CALIFORNIA PTAN
CA
01
—
CA108496
NO. CALIFORNIA PTAN
CA
Enumeration date
09/20/2006
Last updated
01/29/2021
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