Healthcare Provider Details

I. General information

NPI: 1659561488
Provider Name (Legal Business Name): JIMMY T. UY, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2007
Last Update Date: 05/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3576 GRIFFITH PARK BLVD
LOS ANGELES CA
90027-1444
US

IV. Provider business mailing address

3576 GRIFFITH PARK BLVD
LOS ANGELES CA
90027-1444
US

V. Phone/Fax

Practice location:
  • Phone: 323-662-9388
  • Fax: 323-662-4945
Mailing address:
  • Phone: 323-662-9388
  • Fax: 323-662-4945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA40328
License Number StateCA

VIII. Authorized Official

Name: DR. JIMMY T UY
Title or Position: CEO/PRESIDENT
Credential: M.D.
Phone: 213-413-4777