Provider Demographics
NPI:1538235189
Name:WILLIAM H. ISACOFF, M.D. INC.
Entity type:Organization
Organization Name:WILLIAM H. ISACOFF, M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:H
Authorized Official - Last Name:ISACOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-824-4133
Mailing Address - Street 1:2811 WILSHIRE BLVD STE 414
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-4804
Mailing Address - Country:US
Mailing Address - Phone:310-824-4133
Mailing Address - Fax:310-201-6685
Practice Address - Street 1:2811 WILSHIRE BLVD STE 414
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-4804
Practice Address - Country:US
Practice Address - Phone:310-824-4133
Practice Address - Fax:310-201-6685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG24596207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1487729489OtherDME NPI
CA1891773123OtherINDIV NPI
CA00G245960Medicaid
CAZZZ 66561 ZOtherBLUE SHIELD OF CA DME
CA90024B002OtherTRICARE PROV ID
CA=========OtherCOMMERCIAL PROV ID
CAZZZ 66561 ZOtherBLUE SHIELD OF CA DME
CA0687520001Medicare NSC
CAZZZ 66561 ZOtherBLUE SHIELD OF CA DME
CA1891773123OtherINDIV NPI