Healthcare Provider Details

I. General information

NPI: 1487570628
Provider Name (Legal Business Name): JASON AKIO ZEIDMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11461 W WASHINGTON BLVD
LOS ANGELES CA
90066-6025
US

IV. Provider business mailing address

11461 W WASHINGTON BLVD
LOS ANGELES CA
90066-6025
US

V. Phone/Fax

Practice location:
  • Phone: 424-543-4336
  • Fax:
Mailing address:
  • Phone: 424-543-4336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT310248
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: