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General NPI Number Information
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NPI Number | 1629258520
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Entity Type | Organization
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Legal Business Name | JACOB M. TSADOK M.D. INC
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Dates
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Enumeration Date | 11/07/2007
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Last Update Date | 11/07/2007
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Provider Practice Location Address
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Address Line | 2080 CENTURY PARK E SUITE 1511
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City | LOS ANGELES
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State | CA
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Zip | 90067-2001
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Country | US
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Telephone | 310-277-9010
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Fax | 310-277-3659
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Provider Business Mailing Address
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Address Line | PO BOX 24971
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City | LOS ANGELES
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State | CA
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Zip | 90024-0971
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Country | US
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Telephone | 310-277-9010
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Fax | 310-277-3659
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Authorized Official
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Title or Position | OWNER
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Name | JACOB M TSADOK
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Credential | M.D.
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Telephone | 310-277-9010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A61419
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License Number State | CA
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