Basic Information
Provider Information
NPI: 1740280932
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JAMAL
FirstName: HYDER
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4300 ROSE DR
Address2:  
City: YORBA LINDA
State: CA
PostalCode: 928862026
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 4300 ROSE DR
Address2:  
City: YORBA LINDA
State: CA
PostalCode: 928862026
CountryCode: US
TelephoneNumber: 7145284211
FaxNumber: 7145796868
Other Information
ProviderEnumerationDate: 07/28/2005
LastUpdateDate: 11/03/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 11/03/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RG0100XA63346CAY Allopathic & Osteopathic PhysiciansInternal MedicineGastroenterology

No ID Information.


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