MEDICARE: JEHAN ZEB MIR MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	A24647	CA
2	2086S0129X	Vascular Surgery Physician	A24647	CA
3	208D00000X	General Practice Physician	A24647	CA
4	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	A24647	CA

General Provider Information

NPI Number	:	1750495628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEHAN ZEB MIR MD

Provider Business Mailing Address
First Line	:	1715 VIA EL PRADO
Second Line	:	64
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-5713
Country	:	US
Telephone Number	:	310-951-9175
Fax Number	:	310-375-1055

Provider Business Practice Location Address
First Line	:	301 N PRAIRIE AVE
Second Line	:	120
City	:	INGLEWOOD
State	:	CA
Zip	:	90301-4507
Country	:	US
Telephone Number	:	310-677-6101
Fax Number	:	310-677-9327

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	09/11/2025

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