Healthcare Provider Details

I. General information

NPI: 1063740025
Provider Name (Legal Business Name): EMERY JAKAB MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2009
Last Update Date: 12/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 N FIGUEROA ST
LOS ANGELES CA
90012-2602
US

IV. Provider business mailing address

624 SWARTHMORE AVE
PACIFIC PALISADES CA
90272-4351
US

V. Phone/Fax

Practice location:
  • Phone: 213-240-8117
  • Fax:
Mailing address:
  • Phone: 310-428-9339
  • Fax: 310-230-1171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberA54377
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: