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General NPI Number Information
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NPI Number | 1053855486
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Entity Type | Organization
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Legal Business Name | KIRTI TALOLE MD INC
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Dates
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Enumeration Date | 12/04/2016
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Last Update Date | 12/04/2016
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Provider Practice Location Address
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Address Line | 6301 GLADE AVE K213
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City | WOODLAND HILLS
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State | CA
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Zip | 91367-1939
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Country | US
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Telephone | 818-852-9320
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Fax | 818-350-1105
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Provider Business Mailing Address
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Address Line | 6301 GLADE AVE K213
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City | WOODLAND HILLS
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State | CA
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Zip | 91367-1939
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Country | US
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Telephone | 818-852-9320
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Fax | 818-350-1105
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | DR. KIRTI SOPAN TALOLE
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Credential | M.D.
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Telephone | 818-852-9320
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | C132757
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License Number State | CA
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