1710262571 NPI number — JAMAL HUSSAIN MD INC

Table of content: (NPI 1710262571)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710262571 NPI number — JAMAL HUSSAIN MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAMAL HUSSAIN MD INC
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:
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:
1710262571
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3939
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKEWOOD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90711-3939
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-630-7711
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3650 SOUTH ST
Provider Second Line Business Practice Location Address:
STE 105
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90712-1502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-630-7711
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/12/2011

Additional Information

Authorized Official

Authorized Official Last Name:
HUSSAIN
Authorized Official First Name:
JAMAL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
562-630-7711

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X , with the licence number:  C52498 , 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: 1922031806 . This is a "NPI-INDIVIDUAL" identifier . This identifiers is of the category "OTHER".




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