Provider Demographics
NPI:1356478598
Name:KANTOR, WALTER STANLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:STANLEY
Last Name:KANTOR
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 1:23412 MOULTON PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1732
Mailing Address - Country:US
Mailing Address - Phone:949-770-6096
Mailing Address - Fax:
Practice Address - Street 1:23412 MOULTON PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1732
Practice Address - Country:US
Practice Address - Phone:949-770-6096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3318213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE3318Other1
CA000E33180Medicaid
CAE3318Medicare ID - Type Unspecified
CA000E33180Medicaid
CAT11632Medicare UPIN