Provider Demographics
NPI:1972830115
Name:JASVANT N. MODI, M.D., INC.
Entity Type:Organization
Organization Name:JASVANT N. MODI, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-250-3716
Mailing Address - Street 1:1100 W SUNSET BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-1217
Mailing Address - Country:US
Mailing Address - Phone:213-250-3716
Mailing Address - Fax:213-250-5682
Practice Address - Street 1:711 N ALVARADO ST STE 112
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-4016
Practice Address - Country:US
Practice Address - Phone:213-483-3535
Practice Address - Fax:213-250-5682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-09
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA39818174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A398180Medicaid
CAA39818Medicare UPIN