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1215038377 NPI number — JEAN-JACQUES ELBAZ D.D.S., M.S.

NPI Number: 1215038377
Health Care Provider/Practitioner: JEAN-JACQUES ELBAZ D.D.S., M.S.

Information about “1215038377” NPI (JEAN-JACQUES ELBAZ D.D.S., M.S.) exists in 1215038377 in HTML format HTML  |  1215038377 in plain Text format TXT  |  1215038377 in PDF (Portable Document Format) PDF  |  1215038377 in an XML format XML  formats.

NPI Number : 1215038377 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1215038377",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ELBAZ",
    "FirstName": "JEAN-JACQUES",
    "MiddleName": null,
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "D.D.S., M.S.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "9465 WILSHIRE BLVD STE 450",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BEVERLY HILLS",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "90212-2614",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "310-274-0456",
    "MailingAddressFaxNumber": "310-274-0960",
    "FirstLinePracticeLocationAddress": "9465 WILSHIRE BLVD STE 321",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BEVERLY HILLS",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "90212-2602",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "310-274-0456",
    "PracticeLocationAddressFaxNumber": "310-274-0960",
    "EnumerationDate": "09/25/2006",
    "LastUpdateDate": "06/10/2021",
    "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": "1223P0106X",
          "TaxonomyName": "Oral and Maxillofacial Pathology Dentistry",
          "LicenseNumber": "33280",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1223P0300X",
          "TaxonomyName": "Periodontics",
          "LicenseNumber": "33280",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

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