Basic Information
| Provider Information | |||||||||
| NPI: | 1326366279 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SEDGH | ||||||||
| FirstName: | JACOB | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9201 SUNSET BLVD | ||||||||
| Address2: | SUITE #M130 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108882884 | ||||||||
| FaxNumber: | 3102766801 | ||||||||
| Practice Location | |||||||||
| Address1: | 9201 SUNSET BLVD | ||||||||
| Address2: | SUITE #M130 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108882884 | ||||||||
| FaxNumber: | 3102766801 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2010 | ||||||||
| LastUpdateDate: | 11/04/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207YX0905X | A117462 | CA | Y | Allopathic & Osteopathic Physicians | Otolaryngology | Otolaryngology/Facial Plastic Surgery | 174400000X | A117462 | CA | N | Other Service Providers | Specialist |
No ID Information.