Jesse J Licuanan MD a Medical Corporation

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

JESSE J LICUANAN MD A MEDICAL CORPORATION

Practice address

3300 E South St
Suite 205
Lakewood, CA 90805-4549

Phone

(562) 531-0377

Fax

(562) 531-1724

NPI assigned

Apr 19, 2011

Last updated

Apr 19, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jesse J. Licuanan, MDNPI 1396795514

Title

President/Owner

Phone

(562) 531-0377

Specialties & licenses 1

Addresses

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jesse Joseph Licuanan, M.D.

  • Internal Medicine Physician
  • Lakewood, CA
  • NPI 1396795514
  Authorized official Same address or phone
• Ronald Castillo Tejada Jr., MD

  • Internal Medicine Physician
  • Carson, CA
  • NPI 1407165079
  NPD (past)

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

{
    "created_epoch": "1303171200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1303171200000",
    "number": "1114218559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8251 LA PALMA AVE",
            "address_2": "SUITE 434",
            "city": "BUENA PARK",
            "state": "CA",
            "postal_code": "906203205",
            "telephone_number": "562-531-0377",
            "fax_number": "562-531-1724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3300 E SOUTH ST",
            "address_2": "SUITE 205",
            "city": "LAKEWOOD",
            "state": "CA",
            "postal_code": "908054549",
            "telephone_number": "562-531-0377",
            "fax_number": "562-531-1724"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JESSE J LICUANAN MD A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-19",
        "last_updated": "2011-04-19",
        "status": "A",
        "authorized_official_last_name": "LICUANAN",
        "authorized_official_first_name": "JESSE",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "562-531-0377",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hemali Bhakta Jardosh, O.D.
• Tharawadee Jarupan
• Fariba Javadi, M.D.
• JDS Consulting, Inc. (Trust SoCal)
• Bomi Jeon, L.AC.
• Norman Bruce Jetton, MD
• Sharon Jimenez
• Jiten M Vasa, DDS., Inc
• JLSM License Clinical Social Worker, Inc. (Two Doors Therapy Collective)
• Joel F. Brodsky DDS Inc

• Internal Medicine Physician in Lakewood, CA
• Providers in Lakewood, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2011; 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.