Provider Demographics
NPI:1023037223
Name:KOLCHINS, MILTON LEON (MD)
Entity Type:Individual
Prefix:DR
First Name:MILTON
Middle Name:LEON
Last Name:KOLCHINS
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 1:5400 BALBOA BLVD
Mailing Address - Street 2:SUITE # 105
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-1502
Mailing Address - Country:US
Mailing Address - Phone:818-789-0347
Mailing Address - Fax:818-789-3937
Practice Address - Street 1:5400 BALBOA BLVD
Practice Address - Street 2:SUITE # 105
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-1502
Practice Address - Country:US
Practice Address - Phone:818-789-0347
Practice Address - Fax:818-789-3937
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC26885208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACMS051515Medicaid