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General NPI Number Information
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NPI Number | 1194165308
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Entity Type | Organization
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Legal Business Name | ILYA SABSOVICH MD INC A MEDICAL CORPORATION
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Dates
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Enumeration Date | 07/02/2013
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Last Update Date | 07/02/2013
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Provider Practice Location Address
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Address Line | 6140 CAMINO VERDE DR SUITE L
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City | SAN JOSE
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State | CA
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Zip | 95119-1401
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Country | US
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Telephone | 650-580-0939
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Fax |
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Provider Business Mailing Address
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Address Line | 13290 LENNOX WAY
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City | LOS ALTOS HILLS
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State | CA
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Zip | 94022-3542
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Country | US
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Telephone | 650-580-0939
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ILYA SABSOVICH
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Credential | MD
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Telephone | 650-580-0939
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | A115064
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | A115064
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License Number State | CA
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