Individual
DR. JORDAN M USUNOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1540 N TRACY BLVD, A, TRACY, CA 95376-2903
(209) 836-2223
(209) 836-2530
Mailing address
1540 N TRACY BLVD, A, TRACY, CA 95376-2903
(209) 836-2223
(209) 836-2530
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
C38780
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DOC387801
—
CA
Enumeration date
12/18/2006
Last updated
01/31/2008
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