Healthcare Provider Details

I. General information

NPI: 1427206135
Provider Name (Legal Business Name): KENT HOLTORF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2008
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23456 HAWTHORNE BLVD SUITE #160
TORRANCE CA
90505-4716
US

IV. Provider business mailing address

2232 E MAPLE AVE
EL SEGUNDO CA
90245-6507
US

V. Phone/Fax

Practice location:
  • Phone: 310-375-2705
  • Fax:
Mailing address:
  • Phone: 310-375-2705
  • Fax: 310-414-9727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberG74797
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: