MEDICARE: VASANTHI JEYAKUMAR MD

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	207R00000X	Internal Medicine Physician	A49813	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00A498130	OTHER	CA	MEDI CAL

General Provider Information

NPI Number	:	1811994437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VASANTHI JEYAKUMAR MD

Provider Business Mailing Address
First Line	:	2926 N. PALO VERDE AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90815
Country	:	US
Telephone Number	:	562-429-2473
Fax Number	:	562-496-5577

Provider Business Practice Location Address
First Line	:	2926 N. PALO VERDE AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90815
Country	:	US
Telephone Number	:	562-429-2473
Fax Number	:	562-496-5577

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

Provider Enumeration Date	:	06/29/2005
Last Update Date	:	10/29/2012

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