Provider Demographics
NPI:1497853642
Name:JAFFE, YORAM (PH D)
Entity Type:Individual
Prefix:
First Name:YORAM
Middle Name:
Last Name:JAFFE
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 COMSTOCK AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-5316
Mailing Address - Country:US
Mailing Address - Phone:310-277-4080
Mailing Address - Fax:310-277-4080
Practice Address - Street 1:16661 VENTURA BLVD
Practice Address - Street 2:SUITE 603
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-4829
Practice Address - Country:US
Practice Address - Phone:310-277-4080
Practice Address - Fax:310-277-4080
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8237103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY082370Medicaid
CAPSY082370Medicaid
R31220Medicare UPIN