1003389107 NPI number — JAMES JABER MD A MEDICAL CORPORATION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003389107 NPI number — JAMES JABER MD A MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAMES JABER MD A MEDICAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SOUTHERN CA HEAD & NECK SURGERY
Provider Other Organization Name Type Code:
5
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:
1003389107
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/18/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1155 S GRAND AVE APT 807
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90015-2783
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-514-2640
Provider Business Mailing Address Fax Number:
310-935-3369

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
850 S ATLANTIC BLVD STE 305
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTEREY PARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91754-6714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-514-2640
Provider Business Practice Location Address Fax Number:
310-935-3369
Provider Enumeration Date:
01/10/2019

Additional Information

Authorized Official

Authorized Official Last Name:
JABER
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER / PHYSICIAN
Authorized Official Telephone Number:
310-514-2640

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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