Provider Demographics
NPI:1982666152
Name:JEKUMS, THEODORE JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:JAMES
Last Name:JEKUMS
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 1:1801 W ROMNEYA DR
Mailing Address - Street 2:404
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-1830
Mailing Address - Country:US
Mailing Address - Phone:714-535-4747
Mailing Address - Fax:714-535-4054
Practice Address - Street 1:1801 W ROMNEYA DR
Practice Address - Street 2:404
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-1830
Practice Address - Country:US
Practice Address - Phone:714-535-4747
Practice Address - Fax:714-535-4054
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG23626208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G236261Medicaid
CAA42019Medicare UPIN
CA00G236261Medicaid