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NPI Code Detail

MEDICARE: DR. PHILIP DAVID KANOF M.D. PH.D.

MEDICARE: DR. PHILIP DAVID KANOF M.D. PH.D.
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
12084P0800XPsychiatry PhysicianG87632CA

General Provider Information

NPI Number : 1760571608
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PHILIP DAVID KANOF M.D. PH.D.
Provider Business Mailing Address
First Line : 16670 VIA PACIFICA
Second Line :
City : PACIFIC PALISADES
State : CA
Zip : 90272-1947
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 922 S ATLANTIC BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90022-4004
Country : US
Telephone Number : 323-500-1099
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/11/2006
Last Update Date : 12/02/2016

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