Provider Demographics
NPI:1891739108
Name:KAISERMAN, DONALD D (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:D
Last Name:KAISERMAN
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:PO BOX 635
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91793-0635
Mailing Address - Country:US
Mailing Address - Phone:626-813-9988
Mailing Address - Fax:626-813-0075
Practice Address - Street 1:1115 S SUNSET AVE
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3940
Practice Address - Country:US
Practice Address - Phone:626-813-9988
Practice Address - Fax:626-813-0075
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC264552084N0400X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA300034667OtherMEDICARE RR
CAGR0058271OtherMEDI-CAL GROUP NUMBER
CAGR0058270OtherMEDI-CAL GROUP NUMBER
CA00C264550OtherBCBS
CA00C264550Medicaid
CAW11983Medicare PIN
CA00C264550OtherBCBS
CAA87079Medicare UPIN
CATP035Medicare PIN