Individual
DR. JOHN KEITH NYLUND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
14650 AVIATION BLVD, SUITE 235, HAWTHORNE, CA 90250-6656
(310) 643-9333
(310) 643-9337
Mailing address
14650 AVIATION BLVD, SUITE 235, HAWTHORNE, CA 90250-6668
(310) 643-9333
(310) 643-9337
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
CO34111
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CO34111
STATE MEDICAL LISCECE
CA
01
—
W9243
PPTAN #
CA
01
—
WWH7CB
PASSWORD FOR PALMETTO
CA
Enumeration date
04/03/2008
Last updated
09/25/2008
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