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

3055 Wilshire Blvd
Suite150
Los Angeles, CA 90010-1108

Phone

(213) 487-4077

Fax

(213) 487-7517

NPI assigned

Dec 13, 2010

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

(213) 487-4077

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• WILSHIRE RADIOLOGY Other name

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

{
    "created_epoch": "1292198400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1390867200000",
    "number": "1316240393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3055 WILSHIRE BLVD",
            "address_2": "SUITE150",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900101108",
            "telephone_number": "213-487-4077",
            "fax_number": "213-487-7517"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3055 WILSHIRE BLVD",
            "address_2": "SUITE150",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900101108",
            "telephone_number": "213-487-4077",
            "fax_number": "213-487-7517"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "J. BRUCE JACOBS, MD, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-13",
        "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": "213-487-4077",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "A21604",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1316240393",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WILSHIRE RADIOLOGY",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Diagnostic Radiology Physician in Los Angeles, CA
• Providers in Los Angeles, 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.