=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912797101
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LA AND OC FOOT AND ANKLE SURGERY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/09/2025
-----------------------------------------------------
Last Update Date | 07/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5750 DOWNEY AVE STE 203
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90712-1471
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-200-0334
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3034 SPYGLASS CT
-----------------------------------------------------
City | CHINO HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91709-2488
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-419-6781
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JOSEPH YACOUB
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 909-419-6781
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------