Individual
JONATHAN SACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
200 UCLA MEDICAL PLZ, SUITE #214, LOS ANGELES, CA 90095-8344
(310) 794-7788
Mailing address
5767 W CENTURY BLVD, SUITE 200, LOS ANGELES, CA 90045-5632
(310) 301-8708
(310) 301-8751
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
G85834
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G858340
—
CA
Enumeration date
07/26/2006
Last updated
08/13/2010
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