Provider Demographics
NPI:1205191251
Name:NATH, JAIDEV R (MD)
Entity Type:Individual
Prefix:DR
First Name:JAIDEV
Middle Name:R
Last Name:NATH
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Gender:M
Credentials:MD
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Mailing Address - Street 1:4650 SUNSET BLVD - MAILSTOP #94
Mailing Address - Street 2:CHILDREN'S HOSPITAL LOS ANGELES
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-6062
Mailing Address - Country:US
Mailing Address - Phone:323-361-6347
Mailing Address - Fax:323-361-8106
Practice Address - Street 1:4650 W SUNSET BLVD
Practice Address - Street 2:MAILSTOP #94
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6062
Practice Address - Country:US
Practice Address - Phone:323-361-6347
Practice Address - Fax:323-361-8106
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-05
Last Update Date:2015-08-14
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Provider Licenses
StateLicense IDTaxonomies
CA137190208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics