Individual
JACK AZAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11900 AVALON BLVD, #100, LOS ANGELES, CA 90061-2867
(323) 756-1317
(323) 756-4015
Mailing address
11900 AVALON BLVD, #100, LOS ANGELES, CA 90061-2867
(323) 756-1317
(323) 756-4015
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
A54433
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0A544334
—
CA
01
—
1891795613
GROUP/CORPORATION NPI #
CA
Enumeration date
10/18/2007
Last updated
06/15/2017
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