Provider Demographics
NPI:1518987114
Name:SARACHEK, JOEL IVAN (MD)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:IVAN
Last Name:SARACHEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5767 W CENTURY BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5632
Mailing Address - Country:US
Mailing Address - Phone:310-998-5868
Mailing Address - Fax:310-998-5871
Practice Address - Street 1:2701 OCEAN PARK BLVD STE 118
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-5219
Practice Address - Country:US
Practice Address - Phone:310-829-8917
Practice Address - Fax:424-212-5938
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG78560207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G785600Medicaid
CAWG78560CMedicare PIN
CAWG78560BMedicare PIN