Basic Information
| Provider Information | |||||||||
| NPI: | 1649294414 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LUNDBERG | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | ARTHUR | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14120 ALONDRA BLVD | ||||||||
| Address2: | STE C | ||||||||
| City: | SANTA FE SPRINGS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906705842 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5624072080 | ||||||||
| FaxNumber: | 5624072082 | ||||||||
| Practice Location | |||||||||
| Address1: | 23500 MADISON ST | ||||||||
| Address2: | |||||||||
| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 905054702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3107842710 | ||||||||
| FaxNumber: | 3107842716 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2006 | ||||||||
| LastUpdateDate: | 03/08/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | A40743 | CA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 00A407430 | 05 | CA | MEDICAID | 00A407430 | 01 | CA | BLUE SHIELD | OTHER |