Provider Demographics
NPI:1588796080
Name:PHILIP YALOWITZ, MD, PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:PHILIP YALOWITZ, MD, PROFESSIONAL CORPORATION
Other - Org Name:PHILIP YALOWITZ, MD
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:A
Authorized Official - Last Name:YALOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-652-8060
Mailing Address - Street 1:8635 W 3RD ST STE 460
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-6111
Mailing Address - Country:US
Mailing Address - Phone:310-652-8060
Mailing Address - Fax:310-652-0334
Practice Address - Street 1:8635 W 3RD ST STE 460
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-6111
Practice Address - Country:US
Practice Address - Phone:310-652-8060
Practice Address - Fax:310-652-0334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC29916208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW4499Medicare ID - Type Unspecified
CAA34067Medicare UPIN