Provider Demographics
NPI:1508960212
Name:ENDOCRINOLOGY & DIABETES SPECIALTY
Entity Type:Organization
Organization Name:ENDOCRINOLOGY & DIABETES SPECIALTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:KUTAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-634-9803
Mailing Address - Street 1:3300 E SOUTH ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90805-4549
Mailing Address - Country:US
Mailing Address - Phone:562-634-9803
Mailing Address - Fax:562-634-9845
Practice Address - Street 1:3300 E SOUTH STREET
Practice Address - Street 2:SUITE 103
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805
Practice Address - Country:US
Practice Address - Phone:562-634-9803
Practice Address - Fax:562-634-9845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ09897ZOtherBLUE SHIELD
CADC9614OtherRAILROAD MEDICARE
CAW18004Medicare PIN
CAZZZ09897ZOtherBLUE SHIELD