# JACK AZAD,M.D.,INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Tri-City Medical Group
- **Organization subpart:** No

## Provider details

- **NPI number:** 1891795613
- **Authorized official:** JACK AZAD M.D. (PRESIDENT)
- **Authorized official phone:** (323) 756-1317

## Contact information

- **Practice address:** 11900 AVALON BLVD STE 101, LOS ANGELES, CA 90061-2867
- **Practice address phone:** (323) 756-1317
- **Practice address fax:** (323) 756-4015
- **Mailing address:** 11900 AVALON BLVD, \#100, LOS ANGELES, CA 90061-2867
- **Mailing address phone:** (323) 756-1317
- **Mailing address fax:** (323) 756-4015

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/22/2005
- **Last updated:** 06/15/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0A544334 | — | CA |