Provider Demographics
NPI:1851421895
Name:SLK DO PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:SLK DO PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:KOSSUTH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:310-980-5788
Mailing Address - Street 1:3437 INGLEWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-1915
Mailing Address - Country:US
Mailing Address - Phone:310-980-5788
Mailing Address - Fax:301-391-7713
Practice Address - Street 1:3437 INGLEWOOD BOULEVARD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066
Practice Address - Country:US
Practice Address - Phone:310-980-5788
Practice Address - Fax:310-391-7713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A5955282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital