Provider Demographics
NPI:1881627362
Name:AL IMAMI, JIHAD SHAKER (MD)
Entity type:Individual
Prefix:
First Name:JIHAD
Middle Name:SHAKER
Last Name:AL IMAMI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1141 N BRAND BL SUITE 400
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202
Mailing Address - Country:US
Mailing Address - Phone:818-500-4700
Mailing Address - Fax:818-547-4706
Practice Address - Street 1:1141 N BRAND BLVD STE 400
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-2583
Practice Address - Country:US
Practice Address - Phone:818-500-4700
Practice Address - Fax:818-547-4706
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30092207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA30092Medicare ID - Type UnspecifiedMEDICARE NUMBER