Provider Demographics
NPI:1598783144
Name:TUMIN, GARRY (MD)
Entity Type:Individual
Prefix:DR
First Name:GARRY
Middle Name:
Last Name:TUMIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6221 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 509
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5201
Mailing Address - Country:US
Mailing Address - Phone:323-653-6431
Mailing Address - Fax:323-653-3895
Practice Address - Street 1:6221 WILSHIRE BLVD
Practice Address - Street 2:SUITE 509
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5201
Practice Address - Country:US
Practice Address - Phone:323-653-6431
Practice Address - Fax:323-653-3895
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA421110207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA42111AMedicare PIN