Healthcare Provider Details

I. General information

NPI: 1235436023
Provider Name (Legal Business Name): JANET DO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2011
Last Update Date: 10/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 ATLANTIC AVE #605
LONG BEACH CA
90813-3408
US

IV. Provider business mailing address

13401 WILSON ST
GARDEN GROVE CA
92844-1817
US

V. Phone/Fax

Practice location:
  • Phone: 562-901-6767
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA113849
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: