Provider Demographics
NPI:1043802937
Name:KATHLEEN JORDAN MD PC
Entity Type:Organization
Organization Name:KATHLEEN JORDAN MD PC
Other - Org Name:TIA SILVER LAKE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PAYER RELATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHANAH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-887-5519
Mailing Address - Street 1:30 E 23RD ST STE 700
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-4408
Mailing Address - Country:US
Mailing Address - Phone:332-203-0933
Mailing Address - Fax:
Practice Address - Street 1:3921 W. SUNSET BOULEVARD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029
Practice Address - Country:US
Practice Address - Phone:646-650-5337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KATHLEEN JORDAN MD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-02-11
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty