Provider Demographics
NPI:1356354864
Name:PITTOKOPITIS, KYRIACOS (MD)
Entity type:Individual
Prefix:DR
First Name:KYRIACOS
Middle Name:
Last Name:PITTOKOPITIS
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 1:1127 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 510
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-3901
Mailing Address - Country:US
Mailing Address - Phone:213-250-1238
Mailing Address - Fax:213-250-1241
Practice Address - Street 1:1127 WILSHIRE BLVD
Practice Address - Street 2:SUITE 510
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-3901
Practice Address - Country:US
Practice Address - Phone:213-250-1238
Practice Address - Fax:213-250-1241
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33928207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A339280Medicaid
CA00A339280OtherBLUE SHIELD
110229975OtherRAILROAD MEDICARE
CA00A339280Medicaid
CAA33928Medicare ID - Type Unspecified