Jesus L. Licuanan, M.D. Inc

Primary specialty

SpecialistTaxonomy code 174400000X

License

A42300 Issued in CA

Legal business name

JESUS L. LICUANAN, M.D. INC

Practice address

6131 Orangethorpe Ave
# 215
Buena Park, CA 90620-1315

Phone

(714) 521-1700

Fax

(714) 521-1003

NPI assigned

May 29, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jesus L Licuanan, M.D.

Title

President/Owner

Phone

(714) 521-1700

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1212019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1497913057",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6131 ORANGETHORPE AVE",
            "address_2": "# 215",
            "city": "BUENA PARK",
            "state": "CA",
            "postal_code": "906201315",
            "telephone_number": "714-521-1700",
            "fax_number": "714-521-1003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6131 ORANGETHORPE AVE",
            "address_2": "# 215",
            "city": "BUENA PARK",
            "state": "CA",
            "postal_code": "906201315",
            "telephone_number": "714-521-1700",
            "fax_number": "714-521-1003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JESUS L. LICUANAN, M.D. INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-29",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "LICUANAN",
        "authorized_official_first_name": "JESUS",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "714-521-1700",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "A42300",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "P-TAN",
            "identifier": "AQ154",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF CALIFORNIA",
            "identifier": "00A423000",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "A42300",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Buena Park, CA
• Providers in Buena Park, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.