=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053541201
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SPENCER KALMAN KOERNER M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/22/2009
-----------------------------------------------------
Last Update Date | 07/22/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8700 BEVERLY BLVD EAST 245
-----------------------------------------------------
City | WEST HOLLYWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90048-1804
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-423-7890
-----------------------------------------------------
Fax | 310-423-0166
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8700 BEVERLY BLVD EAST 245
-----------------------------------------------------
City | WEST HOLLYWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90048-1804
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-423-7890
-----------------------------------------------------
Fax | 310-423-0166
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number | G22273
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------