Provider Demographics
NPI:1679750046
Name:JERUSALEM, JOCELYN TAHIMIC (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOCELYN
Middle Name:TAHIMIC
Last Name:JERUSALEM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1013 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-1205
Mailing Address - Country:US
Mailing Address - Phone:818-662-8811
Mailing Address - Fax:818-662-8818
Practice Address - Street 1:1013 E BROADWAY
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-1205
Practice Address - Country:US
Practice Address - Phone:818-662-8811
Practice Address - Fax:818-662-8818
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA435371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice