Provider Demographics
NPI:1619152352
Name:JEFFREY H. KATZ, D.P.M., INC.
Entity Type:Organization
Organization Name:JEFFREY H. KATZ, D.P.M., INC.
Other - Org Name:PREMIER FOOT & ANKLE GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:H
Authorized Official - Last Name:KATZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:714-974-3338
Mailing Address - Street 1:6200 E CANYON RIM RD
Mailing Address - Street 2:SUITE 111E
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-4317
Mailing Address - Country:US
Mailing Address - Phone:714-974-3338
Mailing Address - Fax:714-974-7683
Practice Address - Street 1:1881 CALIFORNIA AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-7299
Practice Address - Country:US
Practice Address - Phone:951-735-8806
Practice Address - Fax:951-735-6813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3438213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E34380Medicaid
CA000E34380Medicaid
CAT19329Medicare UPIN
CAZZZ65384ZMedicare PIN
CAW16846Medicare PIN