Provider Demographics
NPI:1467560045
Name:SYDORAK, ROMAN M (MD)
Entity Type:Individual
Prefix:DR
First Name:ROMAN
Middle Name:M
Last Name:SYDORAK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4760 W SUNSET BLVD
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-6063
Mailing Address - Country:US
Mailing Address - Phone:323-783-7507
Mailing Address - Fax:323-783-8747
Practice Address - Street 1:4760 W SUNSET BLVD
Practice Address - Street 2:3RD FLOOR
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6063
Practice Address - Country:US
Practice Address - Phone:323-783-7507
Practice Address - Fax:323-783-8747
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2021-12-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA679952086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A679950Medicaid