Organization
JONATHAN J TYE, MD A PROFESSIONAL CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JONATHAN TYE M.D., F.A.C.C. (OWNER)
(626) 960-6588
Entity
Organization
Contact information
Practice address
1250 S SUNSET AVE, STE 202, WEST COVINA, CA 91790-3961
(626) 960-6588
(626) 338-0688
Mailing address
1250 S SUNSET AVE, STE 202, WEST COVINA, CA 91790-3961
(626) 960-6588
(626) 338-0688
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
A44747
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A447470
—
CA
01
—
110182967
RAILROAD MEDICARE
—
01
—
FT604A
MEDICARE ORGANIZATION PTAN
—
Enumeration date
01/30/2012
Last updated
11/28/2016
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