Provider Demographics
NPI:1265604581
Name:JEFFREY K. LANDER, M.D., PH.D., INC.
Entity type:Organization
Organization Name:JEFFREY K. LANDER, M.D., PH.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:K
Authorized Official - Last Name:LANDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-766-3426
Mailing Address - Street 1:16300 SAND CANYON AVE
Mailing Address - Street 2:SUITE 612
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3711
Mailing Address - Country:US
Mailing Address - Phone:949-753-1001
Mailing Address - Fax:949-753-1114
Practice Address - Street 1:16300 SAND CANYON AVE
Practice Address - Street 2:SUITE 612
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3711
Practice Address - Country:US
Practice Address - Phone:949-753-1001
Practice Address - Fax:949-753-1114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-26
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA93332174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW22392OtherMEDICARE PTAN