Provider Demographics
NPI:1447254339
Name:GJESDAL, DONALD J (MD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:J
Last Name:GJESDAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:17021 YORBA LINDA BLVD
Mailing Address - Street 2:STE 160
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-3711
Mailing Address - Country:US
Mailing Address - Phone:714-961-0110
Mailing Address - Fax:
Practice Address - Street 1:17021 YORBA LINDA BLVD
Practice Address - Street 2:STE 160
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-3711
Practice Address - Country:US
Practice Address - Phone:714-961-0110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG37094207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA46951Medicare UPIN