Healthcare Provider Details

I. General information

NPI: 1154806487
Provider Name (Legal Business Name): EMILY JAIRAM PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2018
Last Update Date: 12/13/2025
Certification Date: 12/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 ATLANTIC AVE STE 719
LONG BEACH CA
90813-3412
US

IV. Provider business mailing address

1045 ATLANTIC AVE STE 719
LONG BEACH CA
90813-3412
US

V. Phone/Fax

Practice location:
  • Phone: 562-591-1324
  • Fax: 562-437-1054
Mailing address:
  • Phone: 562-591-1324
  • Fax: 562-437-1054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: