Provider Demographics
NPI:1992077614
Name:JOEL ZISK, M.D., INCORPORATED
Entity type:Organization
Organization Name:JOEL ZISK, M.D., INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ZISK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-278-0567
Mailing Address - Street 1:8631 W THIRD ST
Mailing Address - Street 2:SUITE 710E
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048
Mailing Address - Country:US
Mailing Address - Phone:310-278-0567
Mailing Address - Fax:310-854-5672
Practice Address - Street 1:8631 W THIRD ST
Practice Address - Street 2:SUITE 710E
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048
Practice Address - Country:US
Practice Address - Phone:310-278-0567
Practice Address - Fax:310-854-5672
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOEL ZISK, M.D., INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-27
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA17595208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty