Provider Demographics
NPI:1932546033
Name:FRED S. KUYT M.D. A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:FRED S. KUYT M.D. A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:S
Authorized Official - Last Name:KUYT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-488-0202
Mailing Address - Street 1:2080 CENTURY PARK E
Mailing Address - Street 2:STE. 1407
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-2001
Mailing Address - Country:US
Mailing Address - Phone:310-284-8191
Mailing Address - Fax:310-284-8113
Practice Address - Street 1:2080 CENTURY PARK E
Practice Address - Street 2:STE. 1407
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2001
Practice Address - Country:US
Practice Address - Phone:310-284-8191
Practice Address - Fax:310-284-8113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-29
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG37445208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG37445Medicare PIN
CAA91895Medicare UPIN