Provider Demographics
NPI:1124117593
Name:WILLEN, JON F (MD)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:F
Last Name:WILLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:7230 MEDICAL CENTER DR
Mailing Address - Street 2:#203
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-1907
Mailing Address - Country:US
Mailing Address - Phone:818-226-6811
Mailing Address - Fax:818-226-6810
Practice Address - Street 1:7230 MEDICAL CENTER DR
Practice Address - Street 2:#203
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-1907
Practice Address - Country:US
Practice Address - Phone:818-226-6811
Practice Address - Fax:818-226-6810
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAC37027207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C370231Medicaid
CAC37027Medicare ID - Type Unspecified
CA00C370231Medicaid