Healthcare Provider Details

I. General information

NPI: 1205496429
Provider Name (Legal Business Name): JEEV PURI MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2019
Last Update Date: 06/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 BELLEFONTAINE ST STE 304
PASADENA CA
91105-3132
US

IV. Provider business mailing address

50 BELLEFONTAINE ST STE 304
PASADENA CA
91105-3132
US

V. Phone/Fax

Practice location:
  • Phone: 626-788-9152
  • Fax:
Mailing address:
  • Phone: 626-788-9152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: SANJEEV PURI
Title or Position: PRESIDENT
Credential: MD
Phone: 626-788-9152