Provider Demographics
NPI:1437490166
Name:JAM MEDICAL GROUP INC
Entity Type:Organization
Organization Name:JAM MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KRIKOR
Authorized Official - Middle Name:BAGHDASSAR
Authorized Official - Last Name:TATOYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:818-670-8990
Mailing Address - Street 1:12826 VICTORY BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-3013
Mailing Address - Country:US
Mailing Address - Phone:818-670-8990
Mailing Address - Fax:818-670-8991
Practice Address - Street 1:12826 VICTORY BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-3013
Practice Address - Country:US
Practice Address - Phone:818-670-8990
Practice Address - Fax:818-670-8991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-05
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC43149208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty