1104914944 NPI number — JIGNESH K PATEL MD PHD

Table of content: JIGNESH K PATEL MD PHD (NPI 1104914944)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104914944 NPI number — JIGNESH K PATEL MD PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PATEL
Provider First Name:
JIGNESH
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD PHD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104914944
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/29/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8536 WILSHIRE BLVD
Provider Second Line Business Mailing Address:
3RD FLOOR
Provider Business Mailing Address City Name:
BEVERLY HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90211-3103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-248-8200
Provider Business Mailing Address Fax Number:
310-248-8333

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8536 WILSHIRE BLVD
Provider Second Line Business Practice Location Address:
3RD FLOOR
Provider Business Practice Location Address City Name:
BEVERLY HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90211-3103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-248-8200
Provider Business Practice Location Address Fax Number:
310-248-8333
Provider Enumeration Date:
10/10/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  A56000 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: A56000 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RA0001X , with the licence number: A56000 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00A560000 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".