Provider Demographics
NPI:1326366279
Name:SEDGH, JACOB (MD)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:SEDGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9201 SUNSET BLVD
Mailing Address - Street 2:SUITE #M130
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90069
Mailing Address - Country:US
Mailing Address - Phone:310-888-2884
Mailing Address - Fax:310-276-6801
Practice Address - Street 1:9201 SUNSET BLVD
Practice Address - Street 2:SUITE #M130
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90069
Practice Address - Country:US
Practice Address - Phone:310-888-2884
Practice Address - Fax:310-276-6801
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-16
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA117462207YX0905X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
No174400000XOther Service ProvidersSpecialist