Provider Demographics
NPI:1871670828
Name:KUSHNER, PAMELA R (MD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:R
Last Name:KUSHNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1100 S HOPE ST
Mailing Address - Street 2:SUITE 915
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-2181
Mailing Address - Country:US
Mailing Address - Phone:562-528-9792
Mailing Address - Fax:847-241-8424
Practice Address - Street 1:1100 S HOPE ST
Practice Address - Street 2:SUITE 915
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-2181
Practice Address - Country:US
Practice Address - Phone:562-528-9792
Practice Address - Fax:847-241-8424
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG53239207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG53239AMedicare ID - Type UnspecifiedMEDICARE NUMBER
CAA93208Medicare UPIN