MEDICARE: DR. PAULA JAN M.D,

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	207R00000X	Internal Medicine Physician	A45642	CA

General Provider Information

NPI Number	:	1841588373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAULA JAN M.D,

Provider Business Mailing Address
First Line	:	17456 BEACH BLVD
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-5913
Country	:	US
Telephone Number	:	858-336-3104
Fax Number	:

Provider Business Practice Location Address
First Line	:	17456 BEACH BLVD
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-5913
Country	:	US
Telephone Number	:	858-336-3104
Fax Number	:

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

Provider Enumeration Date	:	07/19/2011
Last Update Date	:	07/19/2011

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