Provider Demographics
NPI:1841240017
Name:DEMUR, DIMITRY (CEO)
Entity Type:Individual
Prefix:
First Name:DIMITRY
Middle Name:
Last Name:DEMUR
Suffix:
Gender:M
Credentials:CEO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 N KINGSLEY DR
Mailing Address - Street 2:#116
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-5763
Mailing Address - Country:US
Mailing Address - Phone:323-496-6297
Mailing Address - Fax:
Practice Address - Street 1:3540 WILSHIRE BLVD
Practice Address - Street 2:#406
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-2307
Practice Address - Country:US
Practice Address - Phone:213-389-7188
Practice Address - Fax:213-389-7198
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CATG4562279P1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279P1004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredPulmonary Diagnostics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATG456OtherPROVIDER