Provider Demographics
NPI:1477567683
Name:GOODSTEIN, JORDAN HAROLD (MD)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:HAROLD
Last Name:GOODSTEIN
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 1:3831 HUGHES AVE
Mailing Address - Street 2:SUITE 603
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-2751
Mailing Address - Country:US
Mailing Address - Phone:310-559-8886
Mailing Address - Fax:310-559-5104
Practice Address - Street 1:3831 HUGHES AVE
Practice Address - Street 2:SUITE 603
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-2751
Practice Address - Country:US
Practice Address - Phone:310-559-8886
Practice Address - Fax:310-559-5104
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA41353Medicare UPIN
CAG21688Medicare ID - Type Unspecified