Provider Demographics
NPI:1447560859
Name:M. JAY JAZAYERI M.D., INC.
Entity Type:Organization
Organization Name:M. JAY JAZAYERI M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHMOOD
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:JAZAYERI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-595-6426
Mailing Address - Street 1:2690 PACIFIC AVE
Mailing Address - Street 2:SUITE 380
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-2657
Mailing Address - Country:US
Mailing Address - Phone:562-595-6426
Mailing Address - Fax:562-595-5830
Practice Address - Street 1:2690 PACIFIC AVE
Practice Address - Street 2:SUITE 380
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2657
Practice Address - Country:US
Practice Address - Phone:562-595-6426
Practice Address - Fax:562-595-5830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-19
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33300207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A333002Medicaid
CA00A333002Medicaid
CA0298810001Medicare NSC