Healthcare Provider Details

I. General information

NPI: 1730126509
Provider Name (Legal Business Name): LEONARD WILLIAM KRAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 07/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11777 SAN VICENTE BLVD #703
LOS ANGELES CA
90049-5011
US

IV. Provider business mailing address

1521 GREENFIELD AVE #202
LOS ANGELES CA
90025-3422
US

V. Phone/Fax

Practice location:
  • Phone: 310-444-0188
  • Fax: 310-444-0199
Mailing address:
  • Phone: 310-444-0188
  • Fax: 310-444-0199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG24371
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: