Provider Demographics
NPI:1124329594
Name:THEODORE J JEKUMS, MD PC
Entity type:Organization
Organization Name:THEODORE J JEKUMS, MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:JEKUMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-535-4747
Mailing Address - Street 1:1801 W. ROMNEYA DR
Mailing Address - Street 2:STE 404
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-1826
Mailing Address - Country:US
Mailing Address - Phone:714-535-4747
Mailing Address - Fax:714-535-4054
Practice Address - Street 1:1801 W. ROMNEYA DR
Practice Address - Street 2:STE 404
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-1826
Practice Address - Country:US
Practice Address - Phone:714-535-4747
Practice Address - Fax:714-535-4054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-16
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA208600000X
CAG23626208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty