Provider Demographics
NPI:1447232665
Name:GUY, JAN (PA-C)
Entity type:Individual
Prefix:MS
First Name:JAN
Middle Name:
Last Name:GUY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:JAN
Other - Middle Name:
Other - Last Name:GUY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C, MFS
Mailing Address - Street 1:868 EAST 49TH PLACE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90011-4102
Mailing Address - Country:US
Mailing Address - Phone:323-233-9345
Mailing Address - Fax:
Practice Address - Street 1:CAMP CASEY KOREA
Practice Address - Street 2:
Practice Address - City:TONGDUCHON
Practice Address - State:KOREA
Practice Address - Zip Code:96224
Practice Address - Country:KR
Practice Address - Phone:730-4320
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical