Healthcare Provider Details

I. General information

NPI: 1649465840
Provider Name (Legal Business Name): PHILLIP M LEVIN MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 09/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8631 W 3RD ST SUITE 615E
LOS ANGELES CA
90048-5901
US

IV. Provider business mailing address

8631 W 3RD ST SUITE 615E
LOS ANGELES CA
90048-5901
US

V. Phone/Fax

Practice location:
  • Phone: 310-652-8132
  • Fax: 310-659-3815
Mailing address:
  • Phone: 310-652-8132
  • Fax: 310-659-3815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberA21219
License Number StateCA

VIII. Authorized Official

Name: PHILLIP M LEVIN
Title or Position: PRESIDENT
Credential: MD
Phone: 310-652-8132