Basic Information
| Provider Information | |||||||||
| NPI: | 1891843827 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAS | ||||||||
| FirstName: | JAYANTA | ||||||||
| MiddleName: | R. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16542 VENTURA BLVD STE 402 | ||||||||
| Address2: | |||||||||
| City: | ENCINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914364562 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187825041 | ||||||||
| FaxNumber: | 8182059091 | ||||||||
| Practice Location | |||||||||
| Address1: | 14901 RINALDI ST STE 110 | ||||||||
| Address2: | |||||||||
| City: | MISSION HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913451253 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183651339 | ||||||||
| FaxNumber: | 8188984301 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2007 | ||||||||
| LastUpdateDate: | 08/12/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A91850 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | A91850 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RI0011X | A91850 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
No ID Information.