Provider Demographics
NPI:1033163985
Name:JEAN, MICHAEL C (MD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:C
Last Name:JEAN
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:25775 MCBEAN PKWY
Mailing Address - Street 2:SUITE 214
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-3708
Mailing Address - Country:US
Mailing Address - Phone:661-255-2420
Mailing Address - Fax:661-259-0552
Practice Address - Street 1:23928 LYONS AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-2409
Practice Address - Country:US
Practice Address - Phone:661-799-0615
Practice Address - Fax:661-254-3185
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC52532207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ813114Medicaid
H89968Medicare UPIN
75630Medicare ID - Type Unspecified