Provider Demographics
NPI:1427154038
Name:JAMAL, DARYOUSH (MD)
Entity type:Individual
Prefix:DR
First Name:DARYOUSH
Middle Name:
Last Name:JAMAL
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 1:2810 E DEL MAR BLVD
Mailing Address - Street 2:SUITE 14
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-4321
Mailing Address - Country:US
Mailing Address - Phone:626-437-1000
Mailing Address - Fax:866-412-0243
Practice Address - Street 1:2810 E DEL MAR BLVD
Practice Address - Street 2:SUITE 14
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-4321
Practice Address - Country:US
Practice Address - Phone:626-437-1000
Practice Address - Fax:866-412-0243
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2015-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA851052084P0804X, 2084P0800X, 207RA0401X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A851050Medicaid
CA00A851050Medicaid