Organization
JACK AZAD,M.D.,INC.
Active
Other names
Tri-City Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
JACK AZAD M.D. (PRESIDENT)
(323) 756-1317
Entity
Organization
Contact information
Practice address
11900 AVALON BLVD STE 101, 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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0A544334
—
CA
Enumeration date
07/22/2005
Last updated
06/15/2021
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