Provider Demographics
NPI:1407043078
Name:JACK M. GINDI, M.D. A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:JACK M. GINDI, M.D. A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:B
Authorized Official - Last Name:GINDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-706-1617
Mailing Address - Street 1:29525 CANWOOD ST
Mailing Address - Street 2:SUITE # 209
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-4233
Mailing Address - Country:US
Mailing Address - Phone:818-706-1617
Mailing Address - Fax:818-706-0390
Practice Address - Street 1:29525 CANWOOD ST
Practice Address - Street 2:SUITE # 209
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-4233
Practice Address - Country:US
Practice Address - Phone:818-706-1617
Practice Address - Fax:818-706-0390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty