Provider Demographics
NPI:1750317772
Name:KATZ, BERNARD J (MD)
Entity Type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:J
Last Name:KATZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5767 W. CENTURY BLVD
Mailing Address - Street 2:400
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5655
Mailing Address - Country:US
Mailing Address - Phone:310-417-5901
Mailing Address - Fax:310-410-1001
Practice Address - Street 1:881 ALMA REAL DR
Practice Address - Street 2:214
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-3731
Practice Address - Country:US
Practice Address - Phone:310-459-2363
Practice Address - Fax:310-459-1517
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA45158207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14560DOtherMEDICARE PTAN
CAWA45158LMedicare PIN
CAW14560DOtherMEDICARE PTAN