JACK AZADM.D.INC. NPI 1891795613

NPI Information

  • NPI: 1891795613
  • Provider Name: JACK AZAD,M.D.,INC.
  • Classification: General Practice - 208D00000X
  • Entity Type: Organization
  • Doing Business As: TRI-CITY MEDICAL GROUP
  • CLIA Number: 05D2124069
  • Address: 11900 AVALON BLVD STE 101
    LOS ANGELES, CA
    ZIP 90061
  • Phone: (323) 756-1317

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NPI Details

JACK AZAD,M.D.,INC. is a general practice in Los Angeles, CA. The provider is a physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee JACK AZAD,M.D.,INC. NPI is 1891795613. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Tri-city Medical Group.

The provider's business location address is:

11900 AVALON BLVD STE 101
LOS ANGELES, CA
ZIP 90061-867
Phone: (323) 756-1317
Fax: (323) 756-4015

The provider's authorized official is Jack Azad .
The authorized official title is President and has the following contact phone number (323) 756-1317.

The CLIA number assigned to this NPI record is 05D2124069 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 7/22/2005 and was last updated on 6/15/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1208D00000XGeneral PracticeYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
10A544334MEDICAIDCALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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