Healthcare Provider Details

I. General information

NPI: 1215764618
Provider Name (Legal Business Name): JORDAN LACHNISH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2024
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 DERECH SHEBA ST. SHEBA MEDICAL CENTER, ORTHOPEDIC DEPARTMENT
RAMAT GAN ISRAEL
5266202
IL

IV. Provider business mailing address

63 MAZEH ST. ENTRANCE B/ APT 2
TEL AVIV ISRAEL
6578917
IL

V. Phone/Fax

Practice location:
  • Phone: 650-249-6282
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number147185
License Number StateZZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: