Provider Demographics
NPI:1083773055
Name:RUSLANA KADZE MD INC
Entity Type:Organization
Organization Name:RUSLANA KADZE MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RUSLANA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAZDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-343-1717
Mailing Address - Street 1:PO BOX 3098
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90510-3098
Mailing Address - Country:US
Mailing Address - Phone:310-792-3914
Mailing Address - Fax:855-898-4055
Practice Address - Street 1:5525 ETIWANDA AVE STE 228
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-6157
Practice Address - Country:US
Practice Address - Phone:818-343-1717
Practice Address - Fax:818-343-1718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2018-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73273207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA73273Medicare ID - Type Unspecified
CAW17154Medicare PIN