Provider Demographics
NPI:1750495628
Name:MIR, JEHAN ZEB (MD)
Entity Type:Individual
Prefix:
First Name:JEHAN
Middle Name:ZEB
Last Name:MIR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1715 VIA EL PRADO
Mailing Address - Street 2:64
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-5713
Mailing Address - Country:US
Mailing Address - Phone:310-951-9175
Mailing Address - Fax:310-375-1055
Practice Address - Street 1:301 N PRAIRIE AVE
Practice Address - Street 2:120
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-4507
Practice Address - Country:US
Practice Address - Phone:310-677-6101
Practice Address - Fax:310-677-9327
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA24647208600000X, 2086S0129X, 208D00000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgery
Not Answered2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Not Answered208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0816416Medicare UPIN
CAA24647Medicare ID - Type Unspecified