Provider Demographics
NPI:1205861580
Name:ZAKOWSKI, PHILLIP C (MD)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:C
Last Name:ZAKOWSKI
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 1:8635 W 3RD ST STE 465W
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-6111
Mailing Address - Country:US
Mailing Address - Phone:310-358-2300
Mailing Address - Fax:310-358-2308
Practice Address - Street 1:8635 W 3RD ST STE 465W
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-6111
Practice Address - Country:US
Practice Address - Phone:310-358-2300
Practice Address - Fax:310-358-2308
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
CAG44562207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G445620Medicaid
CAE10592Medicare UPIN
CAWG44562BMedicare ID - Type Unspecified