Organization
ILAN BAZAK DPM PROFESSIONAL CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ILAN BAZAK D.P.M (OWNER)
(323) 650-6363
Entity
Organization
Contact information
Practice address
1121 N FAIRFAX AVE, WEST HOLLYWOOD, CA 90046-5306
(323) 650-6363
(323) 650-4377
Mailing address
1121 N FAIRFAX AVE, WEST HOLLYWOOD, CA 90046-5306
(323) 650-6363
(323) 650-4377
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
0559350001
CA
Other
Enumeration date
06/24/2008
Last updated
07/16/2008
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