Healthcare Provider Details

I. General information

NPI: 1659528560
Provider Name (Legal Business Name): KENNETH R. SABBAG MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2008
Last Update Date: 08/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 CONGRESS ST #201
PASADENA CA
91105-3024
US

IV. Provider business mailing address

39 CONGRESS ST #201
PASADENA CA
91105-3024
US

V. Phone/Fax

Practice location:
  • Phone: 626-795-8051
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA71080
License Number StateCA

VIII. Authorized Official

Name: KENNETH R SABBAG
Title or Position: PRESIDENT
Credential: M.D.
Phone: 626-795-8051