# ILAN BAZAK DPM PROFESSIONAL CORP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1396906111
- **Authorized official:** DR. ILAN BAZAK D.P.M (OWNER)
- **Authorized official phone:** (323) 650-6363

## Contact information

- **Practice address:** 1121 N FAIRFAX AVE, WEST HOLLYWOOD, CA 90046-5306
- **Practice address phone:** (323) 650-6363
- **Practice address fax:** (323) 650-4377
- **Mailing address:** 1121 N FAIRFAX AVE, WEST HOLLYWOOD, CA 90046-5306
- **Mailing address phone:** (323) 650-6363
- **Mailing address fax:** (323) 650-4377

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | 0559350001 | CA | Yes |

## Other

- **Enumeration date:** 06/24/2008
- **Last updated:** 07/16/2008