Provider Demographics
NPI:1659787596
Name:TASSIN, JAY GERARD (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:GERARD
Last Name:TASSIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1001 W 17TH ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-1008
Mailing Address - Country:US
Mailing Address - Phone:512-786-2611
Mailing Address - Fax:
Practice Address - Street 1:675 CAMINO DE LOS MARES
Practice Address - Street 2:SUITE 400
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-2835
Practice Address - Country:US
Practice Address - Phone:949-248-4547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAABR BOARD CERT. 19932085R0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG066362OtherCALIFORNIA PHYSICIAN & SURGEON'S LICENSE