Provider Demographics
NPI:1427206135
Name:HOLTORF, KENT (MD)
Entity Type:Individual
Prefix:DR
First Name:KENT
Middle Name:
Last Name:HOLTORF
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 1:2232 E MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-6507
Mailing Address - Country:US
Mailing Address - Phone:310-375-2705
Mailing Address - Fax:310-414-9727
Practice Address - Street 1:23456 HAWTHORNE BLVD
Practice Address - Street 2:SUITE #160
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4716
Practice Address - Country:US
Practice Address - Phone:310-375-2705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-05
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG74797207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
1427206135OtherDO NOT HAVE