Provider Demographics
NPI:1255609780
Name:JAY, ALLEN (MD)
Entity type:Individual
Prefix:
First Name:ALLEN
Middle Name:
Last Name:JAY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:27001 MOULTON PKWY
Mailing Address - Street 2:# 103
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92656-3600
Mailing Address - Country:US
Mailing Address - Phone:949-362-4560
Mailing Address - Fax:949-362-5521
Practice Address - Street 1:27001 MOULTON PKWY
Practice Address - Street 2:# 103
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92656-3600
Practice Address - Country:US
Practice Address - Phone:949-362-4560
Practice Address - Fax:949-362-5521
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA39085207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA39085OtherSTATE LICENSE