Healthcare Provider Details

I. General information

NPI: 1568558013
Provider Name (Legal Business Name): SAJJAD AYUB YACOOB MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 SUNSET BLVD
LOS ANGELES CA
90027-6062
US

IV. Provider business mailing address

6430 SUNSET BLVD SUITE 600
LOS ANGELES CA
90028-7900
US

V. Phone/Fax

Practice location:
  • Phone: 323-669-2534
  • Fax: 323-906-8003
Mailing address:
  • Phone: 323-669-2337
  • Fax: 323-644-8488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG76710
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: