Provider Demographics
NPI:1508986266
Name:KANTER, PHILLIP JAY (MD , FACS)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:JAY
Last Name:KANTER
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Gender:M
Credentials:MD , FACS
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Mailing Address - Street 1:99 N LA CIENEGA BLVD STE 304
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2286
Mailing Address - Country:US
Mailing Address - Phone:310-659-6662
Mailing Address - Fax:310-278-9882
Practice Address - Street 1:99 N LA CIENEGA BLVD STE 304
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2286
Practice Address - Country:US
Practice Address - Phone:310-659-6662
Practice Address - Fax:310-278-9882
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG35881207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG35881OtherCA LICENSE NUMBER
CAE02627Medicare UPIN