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General NPI Number Information
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NPI Number | 1649236423
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Entity Type | Individual
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Provider Name | DAVID SAMUEL TICHANSKY MD
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Gender | Male
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Dates
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Enumeration Date | 04/21/2006
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Last Update Date | 10/23/2023
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Provider Practice Location Address
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Address Line | 200 MEDICAL PLAZA SUITE 214
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City | LOS ANGELES
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State | CA
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Zip | 90095-5563
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Country | US
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Telephone | 310-794-7788
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Fax |
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Provider Business Mailing Address
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Address Line | 5767 W CENTURY BLVD STE 400
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City | LOS ANGELES
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State | CA
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Zip | 90045-5631
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MD066823L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 38725
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 25MA07587100
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License Number State | NJ
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Taxonomy #4
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | C190984
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License Number State | CA
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