Provider Demographics
NPI:1912903048
Name:STAN, ROBIN N (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:N
Last Name:STAN
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 1:501 E HARDY ST
Mailing Address - Street 2:STE 200
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-4057
Mailing Address - Country:US
Mailing Address - Phone:310-672-3900
Mailing Address - Fax:310-672-8438
Practice Address - Street 1:501 E HARDY ST
Practice Address - Street 2:STE 200
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-4057
Practice Address - Country:US
Practice Address - Phone:310-672-3900
Practice Address - Fax:310-672-8438
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG84994174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G849940Medicaid
CA95-4170981OtherGROUP PROVIDER ID
CAG84994OtherMEDICAL LICENSE
CAG08463Medicare UPIN
CA00G849940Medicaid