Provider Demographics
NPI:1124107149
Name:KRUGLYAKOV, SVETLANA (MD)
Entity type:Individual
Prefix:DR
First Name:SVETLANA
Middle Name:
Last Name:KRUGLYAKOV
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 W OLYMPIC BLVD STE 503B
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-4679
Mailing Address - Country:US
Mailing Address - Phone:310-993-0882
Mailing Address - Fax:323-456-0501
Practice Address - Street 1:5901 W OLYMPIC BLVD # 503-A
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-4667
Practice Address - Country:US
Practice Address - Phone:323-456-0500
Practice Address - Fax:323-456-0501
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA934382080A0000X, 208000000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No174400000XOther Service ProvidersSpecialist