Provider Demographics
NPI:1396776241
Name:KUTNIK, LEONARD ALLEN (MD)
Entity type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:ALLEN
Last Name:KUTNIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5950 CASTLE DR
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-2734
Mailing Address - Country:US
Mailing Address - Phone:510-530-2942
Mailing Address - Fax:510-450-3067
Practice Address - Street 1:1835 ALCATRAZ AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94703-2714
Practice Address - Country:US
Practice Address - Phone:510-428-3472
Practice Address - Fax:510-450-5892
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA 22687208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics