Healthcare Provider Details

I. General information

NPI: 1982774147
Provider Name (Legal Business Name): MICHAEL MALKIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 11/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 N VISTA ST
LOS ANGELES CA
90036-2710
US

IV. Provider business mailing address

120 N VISTA ST
LOS ANGELES CA
90036-2710
US

V. Phone/Fax

Practice location:
  • Phone: 323-933-3441
  • Fax:
Mailing address:
  • Phone: 323-933-3441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License NumberC33360
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberC33360
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: