Provider Demographics
NPI:1710001193
Name:WALTER F KERWIN MD A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:WALTER F KERWIN MD A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:F
Authorized Official - Last Name:KERWIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-289-0141
Mailing Address - Street 1:8631 W 3RD ST
Mailing Address - Street 2:SUITE 1017
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5901
Mailing Address - Country:US
Mailing Address - Phone:310-289-0141
Mailing Address - Fax:310-289-0144
Practice Address - Street 1:8631 W 3RD ST
Practice Address - Street 2:SUITE 1017
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5901
Practice Address - Country:US
Practice Address - Phone:310-289-0141
Practice Address - Fax:310-289-0144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG75336174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG75336Medicare ID - Type Unspecified