Provider Demographics
NPI:1164592556
Name:BURSTIN, CHARLES JOEL (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:JOEL
Last Name:BURSTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8631 W 3RD ST
Mailing Address - Street 2:SUITE 1015E
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5901
Mailing Address - Country:US
Mailing Address - Phone:424-230-5377
Mailing Address - Fax:310-358-2266
Practice Address - Street 1:8631 W 3RD ST
Practice Address - Street 2:SUITE 1015E
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5901
Practice Address - Country:US
Practice Address - Phone:424-230-5377
Practice Address - Fax:310-358-2266
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA20389207RN0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A203890Medicaid
CA00A203890Medicaid
CAA22145Medicare UPIN