Healthcare Provider Details

I. General information

NPI: 1841240017
Provider Name (Legal Business Name): DIMITRY DEMUR CEO
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3540 WILSHIRE BLVD #406
LOS ANGELES CA
90010-2307
US

IV. Provider business mailing address

1345 N KINGSLEY DR #116
LOS ANGELES CA
90027-5763
US

V. Phone/Fax

Practice location:
  • Phone: 213-389-7188
  • Fax: 213-389-7198
Mailing address:
  • Phone: 323-496-6297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279P1004X
TaxonomyPulmonary Diagnostics Registered Respiratory Therapist
License NumberTG456
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: