1003916727 NPI number — M. MAZEN JAMAL M.D., M.P.H.

NPI Number: 1003916727
Health Care Provider/Practitioner: M. MAZEN JAMAL M.D., M.P.H.

NPI Number : 1003916727 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1003916727",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "JAMAL",
    "FirstName": "M. MAZEN",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "M.D., M.P.H.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "JAMAL",
    "OtherFirstName": "MOHAMMAD MAZEN",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "M.D., M.P.H.",
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "29 PRAIRE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "IRVIN",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "92618",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "949-813-5115",
    "MailingAddressFaxNumber": "949-825-5189",
    "FirstLinePracticeLocationAddress": "2097 COMPTON AVE STE 103",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CORONA",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92881-7289",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "951-934-0505",
    "PracticeLocationAddressFaxNumber": "951-444-7749",
    "EnumerationDate": "09/23/2006",
    "LastUpdateDate": "06/24/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207RG0100X",
          "TaxonomyName": "Gastroenterology Physician",
          "LicenseNumber": "12734",
          "LicenseNumberStateCode": "NV",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207RG0100X",
          "TaxonomyName": "Gastroenterology Physician",
          "LicenseNumber": "A46078",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}