Provider Demographics
NPI:1568564193
Name:AMIN, JAY S (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:S
Last Name:AMIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JAYENDRAKUMAR
Other - Middle Name:S
Other - Last Name:AMIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6027 E WEST VIEW DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869-4323
Mailing Address - Country:US
Mailing Address - Phone:714-538-6606
Mailing Address - Fax:
Practice Address - Street 1:6027 E WEST VIEW DR
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92869-4323
Practice Address - Country:US
Practice Address - Phone:714-235-3959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-03
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40490207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A404901Medicare ID - Type Unspecified
CAA88529Medicare UPIN