Healthcare Provider Details

I. General information

NPI: 1447693973
Provider Name (Legal Business Name): JACOB LEE WESTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2013
Last Update Date: 04/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MEDICAL PLAZA DRIVEWAY STE 550 UCLA DEPARTMENT OF HEAD AND NECK SURGERY
LOS ANGELES CA
90095-0001
US

IV. Provider business mailing address

200 MEDICAL PLAZA DRIVEWAY STE 550 UCLA DEPARTMENT OF HEAD AND NECK SURGERY
LOS ANGELES CA
90095-0001
US

V. Phone/Fax

Practice location:
  • Phone: 310-206-6688
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberA123456
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: