Provider Demographics
NPI:1801981774
Name:PIETY, JARED LEIGH (MD)
Entity type:Individual
Prefix:DR
First Name:JARED
Middle Name:LEIGH
Last Name:PIETY
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 1:6510 E SPRING ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-1554
Mailing Address - Country:US
Mailing Address - Phone:562-421-4791
Mailing Address - Fax:562-496-1180
Practice Address - Street 1:6510 E SPRING ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-1554
Practice Address - Country:US
Practice Address - Phone:562-421-4791
Practice Address - Fax:562-496-1180
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC28360208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C28360Medicaid
CA00C28360Medicaid