Healthcare Provider Details

I. General information

NPI: 1326278839
Provider Name (Legal Business Name): RYAN H. KOTTON, M.D. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2009
Last Update Date: 10/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8635 W 3RD ST SUITE 465W
LOS ANGELES CA
90048-6101
US

IV. Provider business mailing address

8635 W 3RD ST SUITE 465W
LOS ANGELES CA
90048-6101
US

V. Phone/Fax

Practice location:
  • Phone: 310-935-4065
  • Fax: 310-935-4075
Mailing address:
  • Phone: 310-935-4065
  • Fax: 310-935-4075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA107539
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberA107539
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2081P0010X
TaxonomyPediatric Rehabilitation Medicine Physician
License NumberA107539
License Number StateCA

VIII. Authorized Official

Name: DR. RYAN H. KOTTON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-935-4065