Provider Demographics
NPI:1508026832
Name:MELSTROM, KURT ALLAN JR (MD)
Entity Type:Individual
Prefix:DR
First Name:KURT
Middle Name:ALLAN
Last Name:MELSTROM
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 512185
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-0185
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:412 W CARROLL AVE STE 200
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-4709
Practice Address - Country:US
Practice Address - Phone:626-914-3921
Practice Address - Fax:626-963-0500
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA135013208600000X, 208C00000X
IL036114508208600000X
NY259161208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery