Provider Demographics
NPI:1376726182
Name:MICHAEL JAZAYERI, INC.
Entity Type:Organization
Organization Name:MICHAEL JAZAYERI, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:JAZAYERI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-307-4185
Mailing Address - Street 1:3972 BARRANCA PKWY
Mailing Address - Street 2:SUITE J-214
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-1204
Mailing Address - Country:US
Mailing Address - Phone:949-307-4185
Mailing Address - Fax:
Practice Address - Street 1:2010 E 1ST ST
Practice Address - Street 2:SUITE 270
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-4006
Practice Address - Country:US
Practice Address - Phone:714-834-0101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-14
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG73210174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG00272Medicare UPIN