Provider Demographics
NPI:1235312497
Name:JAY J. RICHLIN M.D. INC
Entity Type:Organization
Organization Name:JAY J. RICHLIN M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:J
Authorized Official - Last Name:RICHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-815-9411
Mailing Address - Street 1:1835 S LA CIENEGA BLVD
Mailing Address - Street 2:SUITE 255
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-4649
Mailing Address - Country:US
Mailing Address - Phone:310-815-9411
Mailing Address - Fax:310-815-8464
Practice Address - Street 1:1835 S LA CIENEGA BLVD
Practice Address - Street 2:SUITE 255
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-4649
Practice Address - Country:US
Practice Address - Phone:310-815-9411
Practice Address - Fax:310-815-8464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-11
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW1320Medicare PIN