Provider Demographics
NPI:1295034395
Name:JOSHUA JORDAN MEDICAL CORPORATION
Entity Type:Organization
Organization Name:JOSHUA JORDAN MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROYA
Authorized Official - Middle Name:
Authorized Official - Last Name:MASOUD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:714-262-5136
Mailing Address - Street 1:PO BOX 27851
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92809-0128
Mailing Address - Country:US
Mailing Address - Phone:714-262-5136
Mailing Address - Fax:310-499-5261
Practice Address - Street 1:3275 TWEEDY BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-4348
Practice Address - Country:US
Practice Address - Phone:714-262-5136
Practice Address - Fax:310-499-5261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-15
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A10231207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty