Provider Demographics
NPI:1487609459
Name:DAVID KATTAN MD A PROFESSIONAL MEDICAL CORPORATION
Entity type:Organization
Organization Name:DAVID KATTAN MD A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:KATTAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-936-7279
Mailing Address - Street 1:5549 W PICO BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-3919
Mailing Address - Country:US
Mailing Address - Phone:323-936-7279
Mailing Address - Fax:323-936-0461
Practice Address - Street 1:5549 W PICO BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-3919
Practice Address - Country:US
Practice Address - Phone:323-936-7279
Practice Address - Fax:323-936-0461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG69002207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G690020Medicaid
CAG69002Medicare ID - Type UnspecifiedPROVIDER NUMBER
CA00G690020Medicaid