Provider Demographics
NPI:1518765510
Name:HERSHENHOUSE, JACOB SAMUEL
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:SAMUEL
Last Name:HERSHENHOUSE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4080 VIA MARISOL APT 341
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042-5159
Mailing Address - Country:US
Mailing Address - Phone:847-513-1911
Mailing Address - Fax:
Practice Address - Street 1:4080 VIA MARISOL APT 341
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90042-5159
Practice Address - Country:US
Practice Address - Phone:847-513-1911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-05
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program