Provider Demographics
NPI:1467411702
Name:LAJIN, MICHAEL (MD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:LAJIN
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 1:8860 CENTER DR
Mailing Address - Street 2:SUITE 330
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3068
Mailing Address - Country:US
Mailing Address - Phone:619-460-4055
Mailing Address - Fax:619-460-5148
Practice Address - Street 1:8860 CENTER DR
Practice Address - Street 2:SUITE 330
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3068
Practice Address - Country:US
Practice Address - Phone:619-460-4055
Practice Address - Fax:619-460-5148
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301071757207R00000X
CAC53475207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4388499Medicaid
MI110F376980OtherBCBSM
CAGC331AMedicare UPIN
MI0F37698236Medicare ID - Type Unspecified
MI4388499Medicaid