Healthcare Provider Details

I. General information

NPI: 1336331123
Provider Name (Legal Business Name): HOWARD R KNOHL MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2007
Last Update Date: 01/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12235 BEACH BLVD STE 110
STANTON CA
90680-3939
US

IV. Provider business mailing address

12235 BEACH BLVD STE 110
STANTON CA
90680-3939
US

V. Phone/Fax

Practice location:
  • Phone: 714-898-7828
  • Fax: 714-892-8863
Mailing address:
  • Phone: 714-898-7828
  • Fax: 714-892-8863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberG16790
License Number StateCA

VIII. Authorized Official

Name: HOWARD R KNOHL
Title or Position: OWNER PRESIDENT
Credential: MD
Phone: 714-898-7828