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General NPI Number Information
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NPI Number | 1124329594
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Entity Type | Organization
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Legal Business Name | THEODORE J JEKUMS, MD PC
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Dates
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Enumeration Date | 11/16/2010
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Last Update Date | 11/01/2012
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Provider Practice Location Address
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Address Line | 1801 W. ROMNEYA DR STE 404
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City | ANAHEIM
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State | CA
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Zip | 92801-1826
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Country | US
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Telephone | 714-535-4747
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Fax | 714-535-4054
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Provider Business Mailing Address
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Address Line | 1801 W. ROMNEYA DR STE 404
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City | ANAHEIM
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State | CA
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Zip | 92801-1826
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Country | US
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Telephone | 714-535-4747
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Fax | 714-535-4054
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. THEODORE JAMES JEKUMS
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Credential | M.D.
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Telephone | 714-535-4747
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | G23626
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License Number State | CA
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