Provider Demographics
NPI:1003983891
Name:DAVID S KATZIN MD A MEDICAL CORP
Entity Type:Organization
Organization Name:DAVID S KATZIN MD A MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN CORPORATE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:KATZIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-659-9470
Mailing Address - Street 1:8631 WEST THIRD ST
Mailing Address - Street 2:SUITE 610E
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5910
Mailing Address - Country:US
Mailing Address - Phone:310-659-9470
Mailing Address - Fax:310-659-3523
Practice Address - Street 1:8631 WEST THIRD ST
Practice Address - Street 2:SUITE 610E
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5910
Practice Address - Country:US
Practice Address - Phone:310-659-9470
Practice Address - Fax:310-659-3523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG33424Medicare ID - Type Unspecified
A45546Medicare UPIN