Healthcare Provider Details

I. General information

NPI: 1952711640
Provider Name (Legal Business Name): DINA JABAJI D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2014
Last Update Date: 01/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 W SUNSET BLVD MS#94
LOS ANGELES CA
90027-6062
US

IV. Provider business mailing address

3701 WILSHIRE BLVD SUITE 600
LOS ANGELES CA
90010-2804
US

V. Phone/Fax

Practice location:
  • Phone: 323-361-6177
  • Fax:
Mailing address:
  • Phone: 323-361-3550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20A12786
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: