Basic Information
| Provider Information | |||||||||
| NPI: | 1164734422 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FARYNA | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | H. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 911 E 20TH ST STE 300 | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571051045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6055041100 | ||||||||
| FaxNumber: | 6055041101 | ||||||||
| Practice Location | |||||||||
| Address1: | 911 E 20TH ST STE 300 | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571051045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6055041100 | ||||||||
| FaxNumber: | 6055041101 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2010 | ||||||||
| LastUpdateDate: | 02/01/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 50375 | AZ | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 12408 | SD | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | ENROLLED | 05 | MN | MEDICAID |