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NPI Code Detail

MEDICARE: DR. JACOB JOHN FAKOORY M.D.

MEDICARE: DR. JACOB JOHN FAKOORY M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine PhysicianC39375CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1134160609
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JACOB JOHN FAKOORY M.D.
Provider Business Mailing Address
First Line : 1227 ARNO DR
Second Line :
City : SIERRA MADRE
State : CA
Zip : 91024-1568
Country : US
Telephone Number : 626-355-8121
Fax Number : 626-355-8987
Provider Business Practice Location Address
First Line : 1420 S CENTRAL AVE
Second Line :
City : GLENDALE
State : CA
Zip : 91204-2508
Country : US
Telephone Number : 818-502-2344
Fax Number : 818-502-4501
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2006
Last Update Date : 02/28/2008

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