Provider Demographics
NPI:1184799009
Name:PICKUS, KURT F (MD)
Entity type:Individual
Prefix:DR
First Name:KURT
Middle Name:F
Last Name:PICKUS
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 1:3440 WEST LOMITA BOULEVARD
Mailing Address - Street 2:SUITE 442
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4801
Mailing Address - Country:US
Mailing Address - Phone:310-530-5451
Mailing Address - Fax:
Practice Address - Street 1:3440 LOMITA BLVD
Practice Address - Street 2:SUITE 442
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4801
Practice Address - Country:US
Practice Address - Phone:310-530-5451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA22160207N00000X, 207ND0900X, 207NI0002X, 207NP0225X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological Immunology
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA22953Medicare UPIN
CAA22160Medicare ID - Type Unspecified