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General NPI Number Information
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NPI Number | 1205191251
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Entity Type | Individual
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Provider Name | JAIDEV R NATH MD
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Gender | Male
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Dates
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Enumeration Date | 07/05/2012
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Last Update Date | 08/14/2015
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Provider Practice Location Address
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Address Line | 4650 W SUNSET BLVD MAILSTOP #94
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City | LOS ANGELES
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State | CA
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Zip | 90027-6062
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Country | US
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Telephone | 323-361-6347
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Fax | 323-361-8106
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Provider Business Mailing Address
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Address Line | 4650 SUNSET BLVD - MAILSTOP #94 CHILDREN'S HOSPITAL LOS ANGELES
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City | LOS ANGELES
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State | CA
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Zip | 90027-6062
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Country | US
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Telephone | 323-361-6347
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Fax | 323-361-8106
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 137190
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License Number State | CA
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