Provider Demographics
NPI:1992116263
Name:MICHAEL LAJIN, M.D., INC
Entity type:Organization
Organization Name:MICHAEL LAJIN, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDRICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-312-1562
Mailing Address - Street 1:8860 CENTER DR STE 330
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-7001
Mailing Address - Country:US
Mailing Address - Phone:619-460-4055
Mailing Address - Fax:619-460-5148
Practice Address - Street 1:8860 CENTER DR STE 330
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-7001
Practice Address - Country:US
Practice Address - Phone:619-460-4055
Practice Address - Fax:619-460-5148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-08
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC53475207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1467411702OtherINDIVIDUAL NPI
CAGC331AMedicare UPIN