Provider Demographics
NPI:1235337635
Name:JACK FRIEDMAN, M.D., INC
Entity Type:Organization
Organization Name:JACK FRIEDMAN, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-593-1330
Mailing Address - Street 1:2625 W ALAMEDA AVE
Mailing Address - Street 2:SUITE# 514
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4806
Mailing Address - Country:US
Mailing Address - Phone:310-593-1330
Mailing Address - Fax:424-228-5729
Practice Address - Street 1:2625 W ALAMEDA AVE
Practice Address - Street 2:SUITE 514
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4806
Practice Address - Country:US
Practice Address - Phone:916-971-3900
Practice Address - Fax:916-971-3618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-06
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC29269174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty