Provider Demographics
NPI:1811992183
Name:AKMAKJIAN, JACK H (MD)
Entity type:Individual
Prefix:
First Name:JACK
Middle Name:H
Last Name:AKMAKJIAN
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 1:7300 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-3810
Mailing Address - Country:US
Mailing Address - Phone:951-710-1030
Mailing Address - Fax:951-710-1030
Practice Address - Street 1:7300 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-3810
Practice Address - Country:US
Practice Address - Phone:951-710-1030
Practice Address - Fax:951-688-8068
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG62470207X00000X, 207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA200028158OtherRAILROAD MEDICARE
CAE58451Medicare UPIN
CA200028158OtherRAILROAD MEDICARE