1588901979 NPI number — I ZAK DDS PROF DENTAL CORP

Table of content: (NPI 1588901979)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588901979 NPI number — I ZAK DDS PROF DENTAL CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
I ZAK DDS PROF DENTAL CORP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DR. ZAK DOWNEY DENTAL CARE
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588901979
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10501 LAKEWOOD BLVD
Provider Second Line Business Mailing Address:
STE A & B
Provider Business Mailing Address City Name:
DOWNEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90241-2709
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-862-2341
Provider Business Mailing Address Fax Number:
562-861-8350

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10501 LAKEWOOD BLVD
Provider Second Line Business Practice Location Address:
STE A & B
Provider Business Practice Location Address City Name:
DOWNEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90241-2709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-862-2341
Provider Business Practice Location Address Fax Number:
562-861-8350
Provider Enumeration Date:
01/07/2013

Additional Information

Authorized Official

Authorized Official Last Name:
ZAK
Authorized Official First Name:
ILYA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER, DENTIST
Authorized Official Telephone Number:
310-706-5273

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  38238 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 122300000X , with the licence number: 26453 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: 61574 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: 46372 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: 55241 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: 48766 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223E0200X , with the licence number: 20673 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223P0221X , with the licence number: 60315 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223S0112X , with the licence number: 48198 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223X0400X , with the licence number: 57513C , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 38238 . This is a "DENTAL LICENCE NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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