Healthcare Provider Details

I. General information

NPI: 1013013317
Provider Name (Legal Business Name): IRWIN KEVIN WEISS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 08/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10833 LE CONTE AVENUE 12-441 MDCC
LOS ANGELES CA
90095
US

IV. Provider business mailing address

10833 LE CONTE AVENUE 12-441 MDCC
LOS ANGELES CA
90095
US

V. Phone/Fax

Practice location:
  • Phone: 310-206-3952
  • Fax: 310-206-0209
Mailing address:
  • Phone: 310-206-3952
  • Fax: 310-206-0209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberG74628
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberG74628
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: