MEDICARE: I ZAK DDS PROF DENTAL CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	1223E0200X	Endodontics
2	1223G0001X	General Practice Dentistry
3	1223P0106X	Oral and Maxillofacial Pathology Dentistry
4	1223P0221X	Pediatric Dentistry
5	1223P0300X	Periodontics
6	1223P0700X	Prosthodontics
7	1223S0112X	Oral and Maxillofacial Surgery (Dentist)
8	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry
9	122300000X	Dentist

General Provider Information

NPI Number	:	1487208773
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	I ZAK DDS PROF DENTAL CORP

Provider Business Mailing Address
First Line	:	10501 LAKEWOOD BLVD
Second Line	:
City	:	DOWNEY
State	:	CA
Zip	:	90241-2709
Country	:	US
Telephone Number	:	310-503-9277
Fax Number	:

Provider Business Practice Location Address
First Line	:	15301 WASHINGTON AVE
Second Line	:
City	:	SAN LEANDRO
State	:	CA
Zip	:	94579-1811
Country	:	US
Telephone Number	:	510-351-6820
Fax Number	:

Authorized Official
Title or Position	:	CEO/PRESIDENT
Name	:	ILYA ZAK
Credential	:	DDS
Telephone Number	:	310-503-9277

Provider Enumeration Date	:	07/25/2019
Last Update Date	:	07/25/2019

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Directions to “I ZAK DDS PROF DENTAL CORP ” Practice Location

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