Provider Demographics
NPI:1336152099
Name:JAMEI, MOHSEN N/A (MD)
Entity type:Individual
Prefix:DR
First Name:MOHSEN
Middle Name:N/A
Last Name:JAMEI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:N/A
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:808 W 58TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90037-3632
Mailing Address - Country:US
Mailing Address - Phone:323-541-1616
Mailing Address - Fax:323-541-1401
Practice Address - Street 1:15301 S SAN JOSE AVE
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90221-3131
Practice Address - Country:US
Practice Address - Phone:562-630-6825
Practice Address - Fax:562-634-5382
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA84432207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A844320Medicaid
CA00A844320Medicaid
134988Medicare UPIN