Healthcare Provider Details

I. General information

NPI: 1396044566
Provider Name (Legal Business Name): JOSHUA PARKS SASINE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOSHUA PARKS SASINE M.D.

II. Dates (important events)

Enumeration Date: 03/27/2011
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MED PLAZA 365,420,120
LOS ANGELES CA
90024
US

IV. Provider business mailing address

5767 W CENTURY BLVD STE 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 310-206-6909
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License NumberME171210
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberA123262
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: