Healthcare Provider Details

I. General information

NPI: 1457530420
Provider Name (Legal Business Name): JEFFREY S. GOODMAN, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2007
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8635 W 3RD ST # 480W
LOS ANGELES CA
90048-6101
US

IV. Provider business mailing address

8635 W 3RD ST # 480W
LOS ANGELES CA
90048-6101
US

V. Phone/Fax

Practice location:
  • Phone: 310-659-4081
  • Fax:
Mailing address:
  • Phone: 310-659-4081
  • Fax: 310-289-7941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. JEFFREY SCOTT GOODMAN
Title or Position: OWNER
Credential: M.D.
Phone: 310-659-4081