Provider Demographics
NPI:1225271786
Name:J SHAY ANESTHESIA AND PAIN MANAGEMENT
Entity Type:Organization
Organization Name:J SHAY ANESTHESIA AND PAIN MANAGEMENT
Other - Org Name:JS ANESTHESIA AND PAIN MANAGEMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JED
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-957-3224
Mailing Address - Street 1:611 KELLY DR
Mailing Address - Street 2:
Mailing Address - City:BARSTOW
Mailing Address - State:CA
Mailing Address - Zip Code:92311-2919
Mailing Address - Country:US
Mailing Address - Phone:760-957-3224
Mailing Address - Fax:760-957-3053
Practice Address - Street 1:555 S 7TH AVE
Practice Address - Street 2:
Practice Address - City:BARSTOW
Practice Address - State:CA
Practice Address - Zip Code:92311-3043
Practice Address - Country:US
Practice Address - Phone:760-957-3224
Practice Address - Fax:760-957-3053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-14
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC51490174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF17838Medicare UPIN