Healthcare Provider Details

I. General information

NPI: 1225513344
Provider Name (Legal Business Name): YEKATERINA BAKHTA MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2018
Last Update Date: 09/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6222 W MANCHESTER AVE STE A
LOS ANGELES CA
90045-3801
US

IV. Provider business mailing address

6515 GREEN VALLEY CIR UNIT 104
CULVER CITY CA
90230-8084
US

V. Phone/Fax

Practice location:
  • Phone: 310-670-1840
  • Fax:
Mailing address:
  • Phone: 310-612-4065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: YEKATERINA A BAKHTA
Title or Position: PRESIDENT
Credential: MD
Phone: 310-612-4065