Provider Demographics
NPI:1922020205
Name:MACY, JONATHAN ISAAC (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:ISAAC
Last Name:MACY
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 1:8635 W THIRD STREET
Mailing Address - Street 2:SUITE 360W
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-6101
Mailing Address - Country:US
Mailing Address - Phone:310-657-2777
Mailing Address - Fax:310-657-0356
Practice Address - Street 1:8635 W THIRD STREET
Practice Address - Street 2:SUITE 360W
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-6101
Practice Address - Country:US
Practice Address - Phone:310-657-2777
Practice Address - Fax:310-657-0356
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG35551207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G355510Medicaid
CA00G355510Medicaid
CAA46399Medicare UPIN