Provider Demographics
NPI:1750500609
Name:KALIOUNDJI, GUS (MD)
Entity Type:Individual
Prefix:
First Name:GUS
Middle Name:
Last Name:KALIOUNDJI
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 1:133 S OAKHURST DR
Mailing Address - Street 2:#303
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-3518
Mailing Address - Country:US
Mailing Address - Phone:310-278-0530
Mailing Address - Fax:818-887-4222
Practice Address - Street 1:133 S OAKHURST DR
Practice Address - Street 2:#303
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-3518
Practice Address - Country:US
Practice Address - Phone:310-278-0530
Practice Address - Fax:818-887-4222
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA89365207Q00000X, 207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine