Provider Demographics
NPI:1477578193
Name:KATZ, JAMES R (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:KATZ
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 1:201 S ALVARADO ST
Mailing Address - Street 2:SUITE 415
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-2320
Mailing Address - Country:US
Mailing Address - Phone:213-484-4951
Mailing Address - Fax:213-484-4950
Practice Address - Street 1:201 S ALVARADO ST
Practice Address - Street 2:SUITE 415
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-2320
Practice Address - Country:US
Practice Address - Phone:213-484-4951
Practice Address - Fax:213-484-4950
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2010-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG45640207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ08332ZOtherBLUE SHIELD
CA1700083268OtherGROUP NPI NIMBER
CA00G456400Medicaid
CAZZZ08332ZOtherBLUE SHIELD
CA1700083268OtherGROUP NPI NIMBER
CAW16756Medicare ID - Type Unspecified
CAWG45640IMedicare PIN