1831462860 NPI number — ALLAN KURTZ PROFESSIONAL MEDICAL CORP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831462860 NPI number — ALLAN KURTZ PROFESSIONAL MEDICAL CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLAN KURTZ PROFESSIONAL MEDICAL CORP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1831462860
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6325 TOPANGA CANYON BLVD
Provider Second Line Business Mailing Address:
501
Provider Business Mailing Address City Name:
WOODLAND HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91367-2052
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-346-1440
Provider Business Mailing Address Fax Number:
818-346-9356

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6325 TOPANGA CANYON BLVD
Provider Second Line Business Practice Location Address:
501
Provider Business Practice Location Address City Name:
WOODLAND HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91367-2052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-346-1440
Provider Business Practice Location Address Fax Number:
818-346-9356
Provider Enumeration Date:
02/22/2012

Additional Information

Authorized Official

Authorized Official Last Name:
KURTZ
Authorized Official First Name:
ALLEN
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
818-346-1440

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  20A4625 , 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: 20A4625 . This is a "MEDICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 33080508 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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