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General NPI Number Information
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NPI Number | 1124107149
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Entity Type | Individual
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Provider Name | SVETLANA KRUGLYAKOV M.D
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Gender | Female
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 06/22/2022
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Provider Practice Location Address
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Address Line | 5901 W OLYMPIC BLVD # 503-A
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City | LOS ANGELES
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State | CA
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Zip | 90036-4667
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Country | US
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Telephone | 323-456-0500
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Fax | 323-456-0501
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Provider Business Mailing Address
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Address Line | 5901 W OLYMPIC BLVD STE 503B
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City | LOS ANGELES
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State | CA
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Zip | 90036-4679
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Country | US
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Telephone | 310-993-0882
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Fax | 323-456-0501
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | A93438
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A93438
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A93438
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License Number State | CA
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