MEDICARE: JACK AZAD 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	208D00000X	General Practice Physician	A54433	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1891795613	OTHER	CA	GROUP/CORPORATION NPI #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841489440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACK AZAD M.D.

Provider Business Mailing Address
First Line	:	11900 AVALON BLVD
Second Line	:	#100
City	:	LOS ANGELES
State	:	CA
Zip	:	90061-2867
Country	:	US
Telephone Number	:	323-756-1317
Fax Number	:	323-756-4015

Provider Business Practice Location Address
First Line	:	11900 AVALON BLVD
Second Line	:	#100
City	:	LOS ANGELES
State	:	CA
Zip	:	90061-2867
Country	:	US
Telephone Number	:	323-756-1317
Fax Number	:	323-756-4015

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

Provider Enumeration Date	:	10/18/2007
Last Update Date	:	06/15/2017

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Directions to “ JACK AZAD M.D.” Practice Location

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