Provider Demographics
NPI:1548624364
Name:DR. JAY
Entity type:Organization
Organization Name:DR. JAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JKOB
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-210-6606
Mailing Address - Street 1:2121 S SAN PEDRO ST
Mailing Address - Street 2:SUITE #C
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90011-1160
Mailing Address - Country:US
Mailing Address - Phone:310-908-4669
Mailing Address - Fax:
Practice Address - Street 1:2121 S SAN PEDRO ST
Practice Address - Street 2:SUITE #C
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90011-1160
Practice Address - Country:US
Practice Address - Phone:310-908-4669
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-07
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies