Individual
JAN HENRIK TILLISCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
200 MEDICAL PLZ, #365,530,420,120, LOS ANGELES, CA 90095-3075
(310) 825-8811
(310) 208-2870
Mailing address
5767 W CENTURY BLVD, SUITE 200, LOS ANGELES, CA 90045-5632
(310) 825-6205
(310) 208-2870
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
G20497
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G204970
—
CA
05
—
1972523587
—
CA
Enumeration date
07/20/2006
Last updated
11/30/2011
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