Provider Demographics
NPI:1760422067
Name:PARIKH, JAGDISHCHANDR (MD)
Entity Type:Individual
Prefix:DR
First Name:JAGDISHCHANDR
Middle Name:
Last Name:PARIKH
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 1:3114 W BEVERLY BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-2217
Mailing Address - Country:US
Mailing Address - Phone:562-667-6648
Mailing Address - Fax:
Practice Address - Street 1:3114 W BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-2217
Practice Address - Country:US
Practice Address - Phone:562-667-6648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC50485207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ636153B1HOtherMEDICARE BILLING ID
NJ4474201Medicaid
NJ4474201Medicaid