Provider Demographics
NPI:1629258520
Name:JACOB M. TSADOK M.D. INC
Entity Type:Organization
Organization Name:JACOB M. TSADOK M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:M
Authorized Official - Last Name:TSADOK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-277-9010
Mailing Address - Street 1:PO BOX 24971
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-0971
Mailing Address - Country:US
Mailing Address - Phone:310-277-9010
Mailing Address - Fax:310-277-3659
Practice Address - Street 1:2080 CENTURY PARK E
Practice Address - Street 2:SUITE 1511
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2001
Practice Address - Country:US
Practice Address - Phone:310-277-9010
Practice Address - Fax:310-277-3659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61419207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A614190Medicaid