Healthcare Provider Details

I. General information

NPI: 1245195718
Provider Name (Legal Business Name): MAKSYM KUCHMA MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 SAN FERNANDO RD
GLENDALE CA
91204-2738
US

IV. Provider business mailing address

3900 SAN FERNANDO RD
GLENDALE CA
91204-2738
US

V. Phone/Fax

Practice location:
  • Phone: 954-853-3669
  • Fax:
Mailing address:
  • Phone: 954-853-3669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: