Provider Demographics
NPI:1992287718
Name:LYONS, JOHN-DAVID ASIDO (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN-DAVID
Middle Name:ASIDO
Last Name:LYONS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DAVID
Other - Middle Name:ASIDO
Other - Last Name:LYONS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, MPP
Mailing Address - Street 1:2801 S SAN PEDRO ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90011-2023
Mailing Address - Country:US
Mailing Address - Phone:323-233-3100
Mailing Address - Fax:323-233-4100
Practice Address - Street 1:2098 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90011-1235
Practice Address - Country:US
Practice Address - Phone:323-233-3100
Practice Address - Fax:323-233-4100
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA167265207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA167265OtherMEDICAL BOARD OF CALIFORNIA
CA550001520Medicaid