Healthcare Provider Details

I. General information

NPI: 1912797101
Provider Name (Legal Business Name): LA AND OC FOOT AND ANKLE SURGERY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2025
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5750 DOWNEY AVE STE 203
LAKEWOOD CA
90712-1471
US

IV. Provider business mailing address

3034 SPYGLASS CT
CHINO HILLS CA
91709-2488
US

V. Phone/Fax

Practice location:
  • Phone: 562-200-0334
  • Fax:
Mailing address:
  • Phone: 909-419-6781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH YACOUB
Title or Position: OWNER
Credential: DPM
Phone: 909-419-6781