Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | G14879 | CA |
NPI | 1073543369 |
---|---|
Provider Name | Dr. Stephen Sacks |
First Address | Los Angeles, CA 90048-6101 |
Second Address | Los Angeles, CA 90048-6101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2006 |
Last Update Date | 07/12/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A39365 | (02) | CA |