Provider Demographics
NPI:1679512560
Name:JAZAYERI, MAHMOOD JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:MAHMOOD
Middle Name:JAY
Last Name:JAZAYERI
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 1:2690 PACIFIC AVE
Mailing Address - Street 2:SUITE 380
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-2657
Mailing Address - Country:US
Mailing Address - Phone:562-595-6426
Mailing Address - Fax:562-595-4210
Practice Address - Street 1:2690 PACIFIC AVE
Practice Address - Street 2:SUITE 380
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2657
Practice Address - Country:US
Practice Address - Phone:562-595-6426
Practice Address - Fax:562-595-4210
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33300207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A333002Medicaid
CA00A333002Medicaid
CAA27103Medicare UPIN