=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689596538
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MJ MEDICAL & ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/29/2026
-----------------------------------------------------
Last Update Date | 07/29/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3851 KATELLA AVE
-----------------------------------------------------
City | LOS ALAMITOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90720-3309
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-765-7686
-----------------------------------------------------
Fax | 562-371-0062
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12611 ARTESIA BLVD APT 243
-----------------------------------------------------
City | CERRITOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90703-8688
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-765-7686
-----------------------------------------------------
Fax | 562-371-0062
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MICHAEL B LE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 626-765-7686
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------