Provider Demographics
NPI:1124002381
Name:KAZLAUSKAS, LINAS J (MD)
Entity Type:Individual
Prefix:
First Name:LINAS
Middle Name:J
Last Name:KAZLAUSKAS
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:PO BOX 512185
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-0185
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:720 E COLORADO ST
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-1712
Practice Address - Country:US
Practice Address - Phone:818-500-5885
Practice Address - Fax:818-241-2946
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG746792085R0001X, 2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G746790Medicaid
CAWG74679FMedicare PIN
CAWG74679GMedicare PIN
CA00G746792Medicare PIN
CAEG74679OMedicare PIN
CA00G746790Medicaid
CAF41946Medicare UPIN
CA00G746791Medicare PIN