Provider Demographics
NPI:1972994853
Name:POGODIN, TIMUR R (MD)
Entity Type:Individual
Prefix:
First Name:TIMUR
Middle Name:R
Last Name:POGODIN
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 1:10228 TABOR ST
Mailing Address - Street 2:APT 8
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-4836
Mailing Address - Country:US
Mailing Address - Phone:626-316-2275
Mailing Address - Fax:
Practice Address - Street 1:10228 TABOR ST
Practice Address - Street 2:APT 8
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-4836
Practice Address - Country:US
Practice Address - Phone:626-316-2275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-12
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA133706208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice