J. Bruce Jacobs, MD, Inc

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

A21604 Issued in CA

Legal business name

J. BRUCE JACOBS, MD, INC

Practice address

2680 Saturn Ave
Suite 100
Huntington Park, CA 90255-4377

Phone

(323) 584-3334

Fax

(323) 584-3336

NPI assigned

Dec 16, 2010

Last updated

Jan 28, 2014By 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

Dr. Alexander Usmanov, M.D.

Title

President

Phone

(323) 584-3334

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• HUNTINGTON RADIOLOGY Other name

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

{
    "created_epoch": "1292457600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1390867200000",
    "number": "1215230008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2680 SATURN AVE",
            "address_2": "SUITE 100",
            "city": "HUNTINGTON PARK",
            "state": "CA",
            "postal_code": "902554377",
            "telephone_number": "323-584-3334",
            "fax_number": "323-584-3336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2680 SATURN AVE",
            "address_2": "SUITE 100",
            "city": "HUNTINGTON PARK",
            "state": "CA",
            "postal_code": "902554377",
            "telephone_number": "323-584-3334",
            "fax_number": "323-584-3336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "J. BRUCE JACOBS, MD, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-16",
        "last_updated": "2014-01-28",
        "status": "A",
        "authorized_official_last_name": "USMANOV",
        "authorized_official_first_name": "ALEXANDER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "323-584-3334",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "A21604",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1215230008",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HUNTINGTON RADIOLOGY",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Diagnostic Radiology Physician in Huntington Park, CA
• Providers in Huntington Park, CA by specialty
• Diagnostic Radiology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2014; 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.