Provider Demographics
NPI:1548840929
Name:JALALI, JONATHAN AMEEN (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:AMEEN
Last Name:JALALI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11301 WILSHIRE BLVD
Mailing Address - Street 2:BLDG. 500, ROOM 3250
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90073
Mailing Address - Country:US
Mailing Address - Phone:310-478-3711
Mailing Address - Fax:504-988-3971
Practice Address - Street 1:11301 WILSHIRE BLVD
Practice Address - Street 2:BLDG. 500, ROOM 3250
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90073
Practice Address - Country:US
Practice Address - Phone:310-478-3711
Practice Address - Fax:504-988-3971
Is Sole Proprietor?:No
Enumeration Date:2021-04-10
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program