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General NPI Number Information
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NPI Number | 1871775783
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Entity Type | Organization
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Legal Business Name | MK JEFFERSON MD ANESTHESIA SERVICS, INC.
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Dates
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Enumeration Date | 12/03/2007
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Last Update Date | 12/03/2007
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Provider Practice Location Address
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Address Line | 18300 ROSCOE BLVD
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City | NORTHRIDGE
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State | CA
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Zip | 91325-4105
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Country | US
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Telephone | 818-885-8500
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 10076
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City | VAN NUYS
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State | CA
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Zip | 91410-0076
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Country | US
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Telephone | 805-578-8300
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Fax | 805-578-8950
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL K. JEFFERSON
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Credential | MD
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Telephone | 818-885-8500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | G68903C
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | G68903C
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License Number State | CA
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