Healthcare Provider Details

I. General information

NPI: 1720726623
Provider Name (Legal Business Name): SVETLANA KRUGLYAKOV, MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2022
Last Update Date: 05/22/2022
Certification Date: 05/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 W OLYMPIC BLVD STE 503B
LOS ANGELES CA
90036-4679
US

IV. Provider business mailing address

5901 W OLYMPIC BLVD STE 503B
LOS ANGELES CA
90036-4679
US

V. Phone/Fax

Practice location:
  • Phone: 323-456-0500
  • Fax: 323-456-0500
Mailing address:
  • Phone: 323-456-0500
  • Fax: 323-456-0500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: SVETLANA KRUGLYAKOV
Title or Position: PRESIDENT
Credential: MD
Phone: 310-993-0882