Healthcare Provider Details

I. General information

NPI: 1962467258
Provider Name (Legal Business Name): JEFFREY A PUNIM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 05/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17822 BEACH BLVD SUITE 201
HUNTINGTON BEACH CA
92647-7101
US

IV. Provider business mailing address

17822 BEACH BLVD SUITE 201
HUNTINGTON BEACH CA
92647-7101
US

V. Phone/Fax

Practice location:
  • Phone: 714-842-9500
  • Fax: 714-841-0760
Mailing address:
  • Phone: 714-842-9500
  • Fax: 714-841-0760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberG41751
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: