1528075751 NPI number — DR. KENNETH DONALD ELMAN MD

Table of content: DR. KENNETH DONALD ELMAN MD (NPI 1528075751)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528075751 NPI number — DR. KENNETH DONALD ELMAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ELMAN
Provider First Name:
KENNETH
Provider Middle Name:
DONALD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1528075751
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/22/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
29525 CANWOOD ST
Provider Second Line Business Mailing Address:
#305
Provider Business Mailing Address City Name:
AGOURA HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91301-4233
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-707-7789
Provider Business Mailing Address Fax Number:
818-707-7797

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
29525 CANWOOD ST
Provider Second Line Business Practice Location Address:
#305
Provider Business Practice Location Address City Name:
AGOURA HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91301-4233
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-707-7789
Provider Business Practice Location Address Fax Number:
818-707-7797
Provider Enumeration Date:
08/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  G72087 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CB227753 . This is a "GROUP PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: CB227752 . This is a "PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1952318461 . This is a "GROUP NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1528075751 . This is a "NPI INDIVIDUAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com