Provider Demographics
NPI:1457605115
Name:WESTPHAL, JAY (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:WESTPHAL
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:PO BOX 3473
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92659-8473
Mailing Address - Country:US
Mailing Address - Phone:949-351-9890
Mailing Address - Fax:
Practice Address - Street 1:4 PARK PLZ
Practice Address - Street 2:SUITE 500
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-8560
Practice Address - Country:US
Practice Address - Phone:949-351-9890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-02
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG494162083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine