Provider Demographics
NPI:1659442564
Name:IINUMA, JAY K (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:K
Last Name:IINUMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 E 3RD ST STE 904
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90013-1647
Mailing Address - Country:US
Mailing Address - Phone:213-947-3171
Mailing Address - Fax:213-947-3173
Practice Address - Street 1:420 E 3RD ST STE 904
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90013-1647
Practice Address - Country:US
Practice Address - Phone:213-947-3171
Practice Address - Fax:213-947-3173
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG077312207Q00000X
CAG77312207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine