Provider Demographics
NPI:1609923895
Name:LANDAUER, KYLE H (MD)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:H
Last Name:LANDAUER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8610 S SEPULVEDA BLVD
Mailing Address - Street 2:#202
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-4008
Mailing Address - Country:US
Mailing Address - Phone:310-641-0333
Mailing Address - Fax:818-285-5958
Practice Address - Street 1:8610 S SEPULVEDA BLVD
Practice Address - Street 2:#202
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-4008
Practice Address - Country:US
Practice Address - Phone:310-641-0333
Practice Address - Fax:818-285-5958
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC081322207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1609923895OtherNPI
CAG73977Medicare UPIN