Healthcare Provider Details

I. General information

NPI: 1598082919
Provider Name (Legal Business Name): ASIF JILLANI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2010
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 S MAIN ST STE 200
ORANGE CA
92868-3852
US

IV. Provider business mailing address

280 S MAIN ST STE 200
ORANGE CA
92868-3852
US

V. Phone/Fax

Practice location:
  • Phone: 714-634-4567
  • Fax: 714-634-4569
Mailing address:
  • Phone: 714-634-4567
  • Fax: 714-634-4569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number53939
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberA146560
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: