Healthcare Provider Details

I. General information

NPI: 1639829591
Provider Name (Legal Business Name): JACOB PESACHOV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2022
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 E. CESAR CHAVEZ AVE SUITE 2500
LOS ANGELES CA
90033
US

IV. Provider business mailing address

1700 E. CESAR CHAVEZ AVE SUITE 2500
LOS ANGELES CA
90033
US

V. Phone/Fax

Practice location:
  • Phone: 855-522-3682
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080S0012X
TaxonomyPediatric Sleep Medicine Physician
License NumberA203196
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: