Provider Demographics
NPI:1659561488
Name:JIMMY T. UY, M.D., INC.
Entity Type:Organization
Organization Name:JIMMY T. UY, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:T
Authorized Official - Last Name:UY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-413-4777
Mailing Address - Street 1:3576 GRIFFITH PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-1444
Mailing Address - Country:US
Mailing Address - Phone:323-662-9388
Mailing Address - Fax:323-662-4945
Practice Address - Street 1:3576 GRIFFITH PARK BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-1444
Practice Address - Country:US
Practice Address - Phone:323-662-9388
Practice Address - Fax:323-662-4945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-27
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40328208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A403281Medicaid
CAA40328OtherMEDICARE ID
CAA85434Medicare UPIN
CA00A403281Medicaid