Healthcare Provider Details

I. General information

NPI: 1912942731
Provider Name (Legal Business Name): FRED KUYT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 05/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 CENTURY PARK E SUITE 1805
LOS ANGELES CA
90067-2001
US

IV. Provider business mailing address

2080 CENTURY PARK E SUITE 1805
LOS ANGELES CA
90067-2001
US

V. Phone/Fax

Practice location:
  • Phone: 310-488-0202
  • Fax: 310-284-8113
Mailing address:
  • Phone: 310-488-0202
  • Fax: 310-284-8113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberG37445
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: