Provider Demographics
NPI:1215951017
Name:MCKEAN, JOHN W (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
Last Name:MCKEAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4411 LEVERT AVE
Mailing Address - Street 2:
Mailing Address - City:DIAMOND SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:95619-9738
Mailing Address - Country:US
Mailing Address - Phone:530-626-5018
Mailing Address - Fax:530-626-1791
Practice Address - Street 1:4411 LEVERT AVE
Practice Address - Street 2:
Practice Address - City:DIAMOND SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:95619-9738
Practice Address - Country:US
Practice Address - Phone:530-626-5018
Practice Address - Fax:530-626-1791
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA182052084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA21233Medicare UPIN