MEDICARE: DR. IPPOLYTOS ANDREAS KALOFONOS MD, PHD, MPH, MS

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	2084P0800X	Psychiatry Physician	A129889	CA

General Provider Information

NPI Number	:	1477872695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IPPOLYTOS ANDREAS KALOFONOS MD, PHD, MPH, MS

Provider Business Mailing Address
First Line	:	10940 WILSHIRE BLVD
Second Line	:	710
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-3915
Country	:	US
Telephone Number	:	510-219-3615
Fax Number	:	310-794-3288

Provider Business Practice Location Address
First Line	:	10940 WILSHIRE BLVD
Second Line	:	710
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-3915
Country	:	US
Telephone Number	:	510-219-3615
Fax Number	:	310-794-3288

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

Provider Enumeration Date	:	05/27/2010
Last Update Date	:	10/13/2014

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