Provider Demographics
NPI:1811216674
Name:ZEHETNER, JOERG (MD)
Entity Type:Individual
Prefix:
First Name:JOERG
Middle Name:
Last Name:ZEHETNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 SAN PABLO ST
Mailing Address - Street 2:SUITE 514
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-5320
Mailing Address - Country:US
Mailing Address - Phone:323-442-5910
Mailing Address - Fax:323-442-6020
Practice Address - Street 1:1510 SAN PABLO ST
Practice Address - Street 2:SUITE 514
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-5320
Practice Address - Country:US
Practice Address - Phone:323-442-5910
Practice Address - Fax:323-442-6020
Is Sole Proprietor?:No
Enumeration Date:2010-05-19
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA06147474208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAED212ZMedicare UPIN