MEDICARE: KYMORA BERNISHA SCOTLAND MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	A163209	CA

General Provider Information

NPI Number	:	1093005787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYMORA BERNISHA SCOTLAND MD

Provider Business Mailing Address
First Line	:	5767 W CENTURY BLVD STE 400
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-5631
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 UCLA MEDICAL PLZ STE 140
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90095-4306
Country	:	US
Telephone Number	:	310-794-7700
Fax Number	:	310-794-0097

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2011
Last Update Date	:	12/20/2019

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