Healthcare Provider Details

I. General information

NPI: 1497710271
Provider Name (Legal Business Name): JAGDISH SURENDRA BHATT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 03/23/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 LINDEN AVE
LONG BEACH CA
90813-3321
US

IV. Provider business mailing address

8914 YUBA RIVER AVE
FOUNTAIN VALLEY CA
92708-6347
US

V. Phone/Fax

Practice location:
  • Phone: 562-491-9866
  • Fax: 562-491-7966
Mailing address:
  • Phone: 714-962-7910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberA43333
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: