Provider Demographics
NPI:1053855486
Name:KIRTI TALOLE MD INC
Entity Type:Organization
Organization Name:KIRTI TALOLE MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRTI
Authorized Official - Middle Name:SOPAN
Authorized Official - Last Name:TALOLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-852-9320
Mailing Address - Street 1:6301 GLADE AVE
Mailing Address - Street 2:K213
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-1939
Mailing Address - Country:US
Mailing Address - Phone:818-852-9320
Mailing Address - Fax:818-350-1105
Practice Address - Street 1:6301 GLADE AVE
Practice Address - Street 2:K213
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-1939
Practice Address - Country:US
Practice Address - Phone:818-852-9320
Practice Address - Fax:818-350-1105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-04
Last Update Date:2016-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC132757207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty