Provider Demographics
NPI:1598825523
Name:KADZE, RUSLANA (MD)
Entity Type:Individual
Prefix:
First Name:RUSLANA
Middle Name:
Last Name:KADZE
Suffix:
Gender:F
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:PO BOX 3098
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90510-3098
Mailing Address - Country:US
Mailing Address - Phone:310-792-3914
Mailing Address - Fax:855-898-4055
Practice Address - Street 1:18411 CLARK ST STE 300
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3546
Practice Address - Country:US
Practice Address - Phone:818-343-1717
Practice Address - Fax:818-343-1718
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73273207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH35558Medicare UPIN
CAA73273Medicare ID - Type Unspecified
CAWA73273AMedicare PIN