MEDICARE: JACOB FLEISCHMANN 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
1	207RI0200X	Infectious Disease Physician	G40660	CA
2	208M00000X	Hospitalist Physician	G40660	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G40660	OTHER	CA	CA MEDICAL LICENSE
2	11880972	OTHER	CA	CAQH
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376563296
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB FLEISCHMANN M.D.

Provider Business Mailing Address
First Line	:	131 N MARTEL AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90074-0001
Country	:	US
Telephone Number	:	323-931-2555
Fax Number	:

Provider Business Practice Location Address
First Line	:	4841 HOLLYWOOD BLVD
Second Line	:	KAISER PERMANENTE
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-5301
Country	:	US
Telephone Number	:	323-783-6454
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	05/12/2009

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