Provider Demographics
NPI:1275769143
Name:GHASSAN AL-JAZAYRLY, MD, INC
Entity Type:Organization
Organization Name:GHASSAN AL-JAZAYRLY, MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GHASSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AL-JAZAYRLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-660-6200
Mailing Address - Street 1:PO BOX 6
Mailing Address - Street 2:
Mailing Address - City:LA CANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91012-0006
Mailing Address - Country:US
Mailing Address - Phone:323-660-6200
Mailing Address - Fax:323-660-6212
Practice Address - Street 1:1300 N VERMONT AVE
Practice Address - Street 2:SUITE 606
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6005
Practice Address - Country:US
Practice Address - Phone:323-660-6200
Practice Address - Fax:323-660-6212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-05
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52470207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A524700Medicaid
CAG15882Medicare UPIN