Healthcare Provider Details

I. General information

NPI: 1760489371
Provider Name (Legal Business Name): JAY H. GOLAND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2005
Last Update Date: 10/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2925 N. PALO VERDE
LONG BEACH CA
90815
US

IV. Provider business mailing address

2925 N. PALO VERDE
LONG BEACH CA
90815
US

V. Phone/Fax

Practice location:
  • Phone: 714-995-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberG37670
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: