Provider Demographics
NPI:1730190893
Name:LONDON, JEFFREY (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:LONDON
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 1:7345 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 600
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-1910
Mailing Address - Country:US
Mailing Address - Phone:818-347-2921
Mailing Address - Fax:818-346-4436
Practice Address - Street 1:7345 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 600
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-1910
Practice Address - Country:US
Practice Address - Phone:818-347-2921
Practice Address - Fax:818-346-4436
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG43248207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E88714Medicare UPIN