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General NPI Number Information
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NPI Number | 1174621577
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Entity Type | Organization
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Legal Business Name | JEHAN MIR , A PROFESSIONAL MEDICAL CORPORATION
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 301 N PRAIRIE AVE STE 120
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City | INGLEWOOD
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State | CA
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Zip | 90301-4515
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Country | US
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Telephone | 310-677-6101
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Fax | 310-677-0327
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Provider Business Mailing Address
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Address Line | 417 VIA ANITA
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City | REDONDO BEACH
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State | CA
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Zip | 90277-6623
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Country | US
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Telephone | 310-375-1055
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEHAN MIR
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Credential | MD
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Telephone | 310-375-1055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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