Healthcare Provider Details

I. General information

NPI: 1124129788
Provider Name (Legal Business Name): JEFFREY MERRICK DYM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28881 AIROSO ST UNIT 110
RANCHO MISSION VIEJO CA
92694-2487
US

IV. Provider business mailing address

DEPT LA 21789
PASADENA CA
91185-1789
US

V. Phone/Fax

Practice location:
  • Phone: 949-682-2600
  • Fax:
Mailing address:
  • Phone: 949-263-8620
  • Fax: 800-409-7005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA93960
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: