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NPI Code Detail

MEDICARE: JONATHAN PAUL SACKS PHYSICIAN ASSISTANT

MEDICARE:   JONATHAN PAUL SACKS  PHYSICIAN ASSISTANT
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA63531CA

General Provider Information

NPI Number : 1841972668
Entity Type Code : Individual
Provider Name (Legal Business Name) : JONATHAN PAUL SACKS PHYSICIAN ASSISTANT
Provider Business Mailing Address
First Line : 480 CENTRAL AVE
Second Line :
City : PEARL HARBOR
State : HI
Zip : 96860-4908
Country : US
Telephone Number : 808-474-4242
Fax Number :
Provider Business Practice Location Address
First Line : NAVAL HEALTH CLINIC HAWAII
Second Line : 480 CENTRAL AVENUE
City : PEARL HARBOR
State : HI
Zip : 96860
Country : US
Telephone Number : 808-474-4242
Fax Number : 808-471-0918
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2023
Last Update Date : 01/20/2026

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Directions to “ JONATHAN PAUL SACKS PHYSICIAN ASSISTANT” Practice Location

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