Provider Demographics
NPI:1174163703
Name:KORTLANDER, KARAN ANN (NP)
Entity type:Individual
Prefix:
First Name:KARAN
Middle Name:ANN
Last Name:KORTLANDER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11633 SAN VICENTE BLVD STE 230
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-6513
Mailing Address - Country:US
Mailing Address - Phone:310-826-3376
Mailing Address - Fax:310-826-3370
Practice Address - Street 1:2284 E MAPLE AVE
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-6507
Practice Address - Country:US
Practice Address - Phone:818-468-1806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-12
Last Update Date:2020-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95013412207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology