Provider Demographics
NPI:1679677967
Name:KUTAS, ALEX (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:
Last Name:KUTAS
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 1:3300 E SOUTH ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90805-4549
Mailing Address - Country:US
Mailing Address - Phone:562-634-9803
Mailing Address - Fax:562-634-9845
Practice Address - Street 1:3300 E SOUTH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805
Practice Address - Country:US
Practice Address - Phone:562-634-9803
Practice Address - Fax:562-634-9845
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG30388207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00200693OtherRAILROAD MEDICARE
CAW18004AOtherMEDICARE GROUP ID
CAW18004OtherMEDICARE GROUP ID
CA00G303880Medicaid
CAW18004AOtherMEDICARE GROUP ID
CAA44403Medicare UPIN
CAW18004OtherMEDICARE GROUP ID