Healthcare Provider Details

I. General information

NPI: 1114446226
Provider Name (Legal Business Name): JAFARY FOOT & ANKLE SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2017
Last Update Date: 08/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 WILSHIRE BLVD STE 101
SANTA MONICA CA
90403
US

IV. Provider business mailing address

4706 SEPULVEDA BLVD APT 202
SHERMAN OAKS CA
91403-2478
US

V. Phone/Fax

Practice location:
  • Phone: 310-828-0011
  • Fax:
Mailing address:
  • Phone: 909-297-8389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO3878
License Number StateFL

VIII. Authorized Official

Name: DR. HAMED JAFARY
Title or Position: PODIATRIST
Credential: DPM
Phone: 909-297-8389