Provider Demographics
NPI:1518046432
Name:MODI, JASVANT N (MD)
Entity Type:Individual
Prefix:
First Name:JASVANT
Middle Name:N
Last Name:MODI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:711 N ALVARADO ST
Mailing Address - Street 2:SUITE 112
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-4076
Mailing Address - Country:US
Mailing Address - Phone:213-999-7011
Mailing Address - Fax:213-483-0047
Practice Address - Street 1:711 N ALVARADO ST
Practice Address - Street 2:SUITE 112
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-4076
Practice Address - Country:US
Practice Address - Phone:213-999-7011
Practice Address - Fax:213-483-0047
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA39818207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A398180Medicaid
CA00A398181Medicaid
CA1518046432OtherNPI
CAA39818Medicare PIN
CA00A398180Medicaid