Healthcare Provider Details

I. General information

NPI: 1346171360
Provider Name (Legal Business Name): ERIN KODESH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12301 WILSHIRE BLVD STE 200
LOS ANGELES CA
90025-1023
US

IV. Provider business mailing address

11 VILLAGE PKWY
SANTA MONICA CA
90405-2852
US

V. Phone/Fax

Practice location:
  • Phone: 310-828-2293
  • Fax:
Mailing address:
  • Phone: 310-849-5321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP95036394
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95144290
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: