Organization
BAYSIDE ANESTHESIA MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH R. SACKS M.D. (PARTNER)
(310) 440-3131
Entity
Organization
Contact information
Practice address
2121 SANTA MONICA BLVD, SANTA MONICA, CA 90404-2303
(310) 576-7267
Mailing address
PO BOX 60790, PASADENA, CA 91116-6790
(626) 795-6596
(626) 795-8247
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0062790
—
CA
Enumeration date
06/16/2006
Last updated
04/03/2025
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