Provider Demographics
NPI:1679780423
Name:BORIS ZAKS, MD INC
Entity Type:Organization
Organization Name:BORIS ZAKS, MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-552-3376
Mailing Address - Street 1:PO BOX 48349
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-0349
Mailing Address - Country:US
Mailing Address - Phone:310-552-3376
Mailing Address - Fax:
Practice Address - Street 1:240 S LA CIENEGA BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-3324
Practice Address - Country:US
Practice Address - Phone:310-552-3376
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70603207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW20961Medicare PIN