Provider Demographics
NPI:1629438064
Name:LASERMD PAIN RELIEF, INC.
Entity Type:Organization
Organization Name:LASERMD PAIN RELIEF, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAFT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-550-5600
Mailing Address - Street 1:578 WASHINGTON BLVD
Mailing Address - Street 2:1036
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-5442
Mailing Address - Country:US
Mailing Address - Phone:213-550-5600
Mailing Address - Fax:
Practice Address - Street 1:2809 N SEPULVEDA BLVD
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-2727
Practice Address - Country:US
Practice Address - Phone:213-550-5600
Practice Address - Fax:213-325-6425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-27
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA136863261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain