Healthcare Provider Details

I. General information

NPI: 1104943000
Provider Name (Legal Business Name): KYLE MARRAN HURTH MD PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 11/12/2020
Certification Date: 11/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 SAN PABLO ST 2ND FLOOR, SUITE 221
LOS ANGELES CA
90033-5313
US

IV. Provider business mailing address

PO BOX 31309
LOS ANGELES CA
90031-0309
US

V. Phone/Fax

Practice location:
  • Phone: 323-442-2582
  • Fax:
Mailing address:
  • Phone: 323-442-2582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberA126864
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: