Provider Demographics
NPI:1881756096
Name:TSADOK, JACOB M (MD)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:M
Last Name:TSADOK
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: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:
Practice Address - Street 1:11645 WILSHIRE BLVD
Practice Address - Street 2:SUITE 1090
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-6812
Practice Address - Country:US
Practice Address - Phone:310-445-3551
Practice Address - Fax:310-445-3351
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA61419207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
BT4605462OtherDEA
A61419Medicare ID - Type Unspecified
CAG21468Medicare UPIN