MEDICARE: SYDNEY KANTOR

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	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1528642733
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYDNEY KANTOR

Provider Business Mailing Address
First Line	:	606 LAKE ST APT 21
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-4705
Country	:	US
Telephone Number	:	714-296-8119
Fax Number	:

Provider Business Practice Location Address
First Line	:	606 LAKE ST APT 21
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-4705
Country	:	US
Telephone Number	:	714-296-8119
Fax Number	:

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

Provider Enumeration Date	:	05/12/2021
Last Update Date	:	05/12/2021

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