MEDICARE: DR. THAMBIMUTTU JEYARANJAN M.D.

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	208000000X	Pediatrics Physician	A32442	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669589644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THAMBIMUTTU JEYARANJAN M.D.

Provider Business Mailing Address
First Line	:	284 S ATLANTIC BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90022-1733
Country	:	US
Telephone Number	:	323-780-5884
Fax Number	:	323-264-4628

Provider Business Practice Location Address
First Line	:	284 S ATLANTIC BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90022-1733
Country	:	US
Telephone Number	:	323-780-5884
Fax Number	:	323-264-4628

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

Provider Enumeration Date	:	08/24/2006
Last Update Date	:	07/08/2007

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