Healthcare Provider Details

I. General information

NPI: 1871709030
Provider Name (Legal Business Name): JAY APPLEBAUM, M.D.,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17601 17TH ST STE 110
TUSTIN CA
92780-1949
US

IV. Provider business mailing address

17601 17TH ST STE 110
TUSTIN CA
92780-1949
US

V. Phone/Fax

Practice location:
  • Phone: 714-790-0005
  • Fax: 714-699-2444
Mailing address:
  • Phone: 714-790-0005
  • Fax: 714-699-2444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberG54219
License Number StateCA

VIII. Authorized Official

Name: JAY APPLEBAUM
Title or Position: PRESIDENT
Credential: M.D.
Phone: 714-790-0005