Provider Demographics
NPI:1295848679
Name:JIFFRY, AHAMED J (MD)
Entity Type:Individual
Prefix:
First Name:AHAMED
Middle Name:J
Last Name:JIFFRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:399 EAST HIGHLAND AVENUE
Mailing Address - Street 2:SUITE 312
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404
Mailing Address - Country:US
Mailing Address - Phone:909-886-8227
Mailing Address - Fax:909-883-3358
Practice Address - Street 1:399 EAST HIGHLAND AVENUE
Practice Address - Street 2:SUITE 312
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404
Practice Address - Country:US
Practice Address - Phone:909-886-8227
Practice Address - Fax:909-883-3358
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA043501207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A435010Medicaid
ZZZ346365ZOtherBLUE SHIELD
CA00A435011Medicare PIN
ZZZ346365ZOtherBLUE SHIELD