Healthcare Provider Details

I. General information

NPI: 1245805423
Provider Name (Legal Business Name): TESTING MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2021
Last Update Date: 05/20/2021
Certification Date: 05/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 N SAN VICENTE BLVD STE 200
BEVERLY HILLS CA
90211-2325
US

IV. Provider business mailing address

113 N SAN VICENTE BLVD STE 300
BEVERLY HILLS CA
90211-2326
US

V. Phone/Fax

Practice location:
  • Phone: 310-710-4666
  • Fax:
Mailing address:
  • Phone: 310-710-4666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: ABRAHAM MALKIN
Title or Position: CEO
Credential: MD
Phone: 323-333-9634