Provider Demographics
NPI:1518048255
Name:GINDI, JACK M (MD)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:M
Last Name:GINDI
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Gender:M
Credentials:MD
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Mailing Address - Street 1:29525 CANWOOD ST
Mailing Address - Street 2:SUITE # 209
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-4233
Mailing Address - Country:US
Mailing Address - Phone:818-706-7773
Mailing Address - Fax:818-706-0390
Practice Address - Street 1:29525 CANWOOD ST
Practice Address - Street 2:SUITE # 209
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-4233
Practice Address - Country:US
Practice Address - Phone:818-706-7773
Practice Address - Fax:818-706-0390
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2022-01-06
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Provider Licenses
StateLicense IDTaxonomies
CAG056963207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
37-1440121OtherTAX ID #
CAG056963OtherMEDICAL LICENSE
CAA93460Medicare UPIN