Healthcare Provider Details

I. General information

NPI: 1407837347
Provider Name (Legal Business Name): JAY JAHANMIR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JAMSHID JAHANMIR MD

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9040 JACKSON AVE
TACOMA WA
98431-5001
US

IV. Provider business mailing address

5299 SIMONS DR
RENO NV
89523-1872
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-2252
  • Fax:
Mailing address:
  • Phone: 808-725-7933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number16606
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0101265104
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD60585340
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number16606
License Number StateHI
# 5
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number214098
License Number StateMA
# 6
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD60585340
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: