Provider Demographics
NPI:1891843827
Name:DAS, JAYANTA R (MD)
Entity Type:Individual
Prefix:
First Name:JAYANTA
Middle Name:R
Last Name:DAS
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Gender:M
Credentials:MD
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Mailing Address - Street 1:16542 VENTURA BLVD STE 402
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-4562
Mailing Address - Country:US
Mailing Address - Phone:818-782-5041
Mailing Address - Fax:818-205-9091
Practice Address - Street 1:14901 RINALDI ST STE 110
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1253
Practice Address - Country:US
Practice Address - Phone:818-365-1339
Practice Address - Fax:818-898-4301
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2022-08-12
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Provider Licenses
StateLicense IDTaxonomies
CAA91850207R00000X, 207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease