Provider Demographics
NPI:1952407488
Name:KUDROW, DAVID BRUCE (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BRUCE
Last Name:KUDROW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2001 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 880W
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2102
Mailing Address - Country:US
Mailing Address - Phone:310-315-1456
Mailing Address - Fax:310-315-1486
Practice Address - Street 1:2001 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 880W
Practice Address - City:SANTA MONCIA
Practice Address - State:CA
Practice Address - Zip Code:90404-2102
Practice Address - Country:US
Practice Address - Phone:310-315-1456
Practice Address - Fax:310-315-1486
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG621662084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
W14252AMedicare ID - Type Unspecified
CAWG62166GMedicare PIN
E70496Medicare UPIN