MEDICARE: JENNY ASIM GADIA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT295206	CA

General Provider Information

NPI Number	:	1326677485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNY ASIM GADIA

Provider Business Mailing Address
First Line	:	3756 W AVENUE 40
Second Line	:	STE 2B
City	:	LOS ANGELES
State	:	CA
Zip	:	90065-3667
Country	:	US
Telephone Number	:	323-880-9938
Fax Number	:	323-739-0094

Provider Business Practice Location Address
First Line	:	3756 W AVENUE 40
Second Line	:	STE 2B
City	:	LOS ANGELES
State	:	CA
Zip	:	90065-3667
Country	:	US
Telephone Number	:	323-880-9938
Fax Number	:	323-344-2337

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2020
Last Update Date	:	07/24/2021

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Directions to “ JENNY ASIM GADIA ” Practice Location

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