Healthcare Provider Details

I. General information

NPI: 1215022561
Provider Name (Legal Business Name): JEAN CLAUDE HENRY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 02/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 S EUCLID AVE
PASADENA CA
91106-3732
US

IV. Provider business mailing address

655 S EUCLID AVE
PASADENA CA
91106-3732
US

V. Phone/Fax

Practice location:
  • Phone: 626-272-7411
  • Fax:
Mailing address:
  • Phone: 909-338-9880
  • Fax: 909-338-9883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA36648
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: