Provider Demographics
NPI:1346212263
Name:PAUL F JACOBSEN, M.D., A MEDICAL CORPORAION
Entity Type:Organization
Organization Name:PAUL F JACOBSEN, M.D., A MEDICAL CORPORAION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:JACOBSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-698-9743
Mailing Address - Street 1:6512 PAINTER AVE
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90601-4518
Mailing Address - Country:US
Mailing Address - Phone:562-698-9743
Mailing Address - Fax:562-698-1767
Practice Address - Street 1:6512 PAINTER AVE
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90601-4518
Practice Address - Country:US
Practice Address - Phone:562-698-9743
Practice Address - Fax:562-698-1767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG33336207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G33336Medicare ID - Type Unspecified
CAA89550Medicare UPIN