Individual provider Active NPI

Jamal Serhan

  • Driver
  • Irvine, CA
National Provider Identifier
1063169183
Registry record updated Mar 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
DriverTaxonomy code 172A00000X
Practice address
1801 Crescent Oak
Irvine, CA 92618-4027
Phone
(619) 710-5073
NPI assigned
Mar 8, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 8, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Driver 172A00000X Primary

Addresses

Primary practice location

1801 Crescent Oak
Irvine, CA 92618-4027

Mailing address

1927 Harbor Blvd # 522
Costa Mesa, CA 92627-7600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Care 22 LLC CurrentSince Mar 13, 2022 Accepting new patients

Locations

1927 Harbor Blvd
#522
Costa Mesa, CA 92627

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1646697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646697600000",
    "number": "1063169183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1927 HARBOR BLVD # 522",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926277600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 CRESCENT OAK",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926184027",
            "telephone_number": "619-710-5073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SERHAN",
        "first_name": "JAMAL",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-03-08",
        "last_updated": "2022-03-08",
        "certification_date": "2022-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172A00000X",
            "taxonomy_group": "",
            "desc": "Driver",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Irvine, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.