Provider Demographics
NPI:1730126509
Name:KRAM, LEONARD WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:WILLIAM
Last Name:KRAM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1521 GREENFIELD AVE
Mailing Address - Street 2:#202
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-3422
Mailing Address - Country:US
Mailing Address - Phone:310-444-0188
Mailing Address - Fax:310-444-0199
Practice Address - Street 1:11777 SAN VICENTE BLVD
Practice Address - Street 2:#703
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-5011
Practice Address - Country:US
Practice Address - Phone:310-444-0188
Practice Address - Fax:310-444-0199
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2007-07-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG243712084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G243711Medicaid
CAA90869Medicare UPIN