Provider Demographics
NPI:1669846556
Name:TKMD CORP
Entity Type:Organization
Organization Name:TKMD CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:B
Authorized Official - Last Name:KIDNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:3102-589-1518
Mailing Address - Street 1:8631 W 3RD ST
Mailing Address - Street 2:SUITE 200E
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5901
Mailing Address - Country:US
Mailing Address - Phone:310-289-1518
Mailing Address - Fax:310-289-1526
Practice Address - Street 1:8631 W 3RD ST
Practice Address - Street 2:SUITE 200E
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5901
Practice Address - Country:US
Practice Address - Phone:310-289-1518
Practice Address - Fax:310-289-1526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-16
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty