Provider Demographics
NPI:1013013317
Name:WEISS, IRWIN KEVIN (MD)
Entity Type:Individual
Prefix:
First Name:IRWIN
Middle Name:KEVIN
Last Name:WEISS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10833 LE CONTE AVENUE
Mailing Address - Street 2:12-441 MDCC
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095
Mailing Address - Country:US
Mailing Address - Phone:310-206-3952
Mailing Address - Fax:310-206-0209
Practice Address - Street 1:10833 LE CONTE AVENUE
Practice Address - Street 2:12-441 MDCC
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095
Practice Address - Country:US
Practice Address - Phone:310-206-3952
Practice Address - Fax:310-206-0209
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG746282080N0001X, 2080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
No2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0053510Medicaid
CA00G746280Medicaid
CAW11810Medicare ID - Type UnspecifiedGROUP
CA00G746280Medicaid
CAFH524ZMedicare PIN
CAF32931Medicare UPIN