Provider Demographics
NPI:1821030560
Name:KUEMMERLE, NATHAN B (MD)
Entity Type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:B
Last Name:KUEMMERLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:8235 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE #303
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046-5914
Mailing Address - Country:US
Mailing Address - Phone:310-430-4866
Mailing Address - Fax:
Practice Address - Street 1:8235 SANTA MONICA BLVD
Practice Address - Street 2:SUITE #303
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-5914
Practice Address - Country:US
Practice Address - Phone:310-430-4866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA893682084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry