Provider Demographics
NPI:1144400524
Name:CALVIN EZRIN MD, A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:CALVIN EZRIN MD, A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CALVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:EZRIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-996-3936
Mailing Address - Street 1:18372 CLARK STREET
Mailing Address - Street 2:SUITE 226
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-3508
Mailing Address - Country:US
Mailing Address - Phone:818-996-3936
Mailing Address - Fax:818-996-3655
Practice Address - Street 1:18372 CLARK STREET
Practice Address - Street 2:SUITE 226
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3508
Practice Address - Country:US
Practice Address - Phone:818-996-3936
Practice Address - Fax:818-996-3655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG33066207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG33066Medicare PIN
CAA45405Medicare UPIN