Jon P Lake, MD | |
12601 Garden Grove Blvd, Garden Grove, CA 92843-1908 | |
(714) 741-2765 | |
(714) 590-2490 |
Full Name | Jon P Lake |
---|---|
Gender | Male |
Speciality | Pathology |
Experience | 46 Years |
Location | 12601 Garden Grove Blvd, Garden Grove, California |
Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
Identifier | Type | State | Issuer |
---|---|---|---|
1295768786 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207ZP0102X | Pathology - Anatomic Pathology & Clinical Pathology | A84772 (California) | Primary |
207ZC0500X | Pathology - Cytopathology | A84772 (California) | Primary |
Facility Name | Location | Facility Type |
---|---|---|
St Joseph Hospital | Orange, CA | Hospital |
Redlands Community Hospital | Redlands, CA | Hospital |
West Anaheim Medical Center | Anaheim, CA | Hospital |
Garden Grove Hospital & Medical Center | Garden grove, CA | Hospital |
St Bernardine Medical Center | San bernardino, CA | Hospital |
Group Practice Name | Group PECOS PAC ID | No. of Members |
---|---|---|
Affiliated Pathologists Medical Group, Inc. | 7315840535 | 40 |
Entity Name | Affiliated Pathologists Medical Group, Inc. |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1730119553 PECOS PAC ID: 7315840535 Enrollment ID: O20040127000838 |
Mailing Address | Practice Location Address |
---|---|
Jon P Lake, MD Po Box 10076, Van Nuys, CA 91410-0076 Ph: (805) 578-8300 | Jon P Lake, MD 12601 Garden Grove Blvd, Garden Grove, CA 92843-1908 Ph: (714) 741-2765 |
Dr. John Chatfield Hiserodt, M.D. Pathology Medicare: Accepting Medicare Assignments Practice Location: 7707 Garden Grove Blvd, Garden Grove, CA 92841 Phone: 714-902-1762 Fax: 657-400-9073 | |
Dr. Antony Eugene Chen, DO Pathology Medicare: Accepting Medicare Assignments Practice Location: 12601 Garden Grove Blvd, Garden Grove, CA 92843 Phone: 714-741-2765 Fax: 714-537-8968 | |
Si Van Nguyen, M.D. Pathology Medicare: Accepting Medicare Assignments Practice Location: 12601 Garden Grove Blvd, Pathology Dept., Garden Grove, CA 92843 Phone: 949-874-0827 Fax: 310-698-7054 |