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General NPI Number Information
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NPI Number | 1205838257
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Entity Type | Organization
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Legal Business Name | JAY K HARNESS MD A MEDICAL CORPORATION
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Dates
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Enumeration Date | 08/10/2005
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Last Update Date | 02/19/2009
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Provider Practice Location Address
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Address Line | 1000 W LA VETA AVE
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City | ORANGE
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State | CA
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Zip | 92868-4304
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Country | US
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Telephone | 714-744-8601
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Fax | 714-744-8622
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Provider Business Mailing Address
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Address Line | PO BOX 5942
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City | ORANGE
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State | CA
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Zip | 92863-5942
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Country | US
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Telephone | 714-571-5000
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Fax | 714-571-5055
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Authorized Official
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Title or Position | OWNER
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Name | JAY K. HARNESS
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Credential | M.D.
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Telephone | 714-744-8601
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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 |
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