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General NPI Number Information
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NPI Number | 1851421895
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Entity Type | Organization
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Legal Business Name | SLK DO PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 04/12/2011
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Provider Practice Location Address
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Address Line | 3437 INGLEWOOD BOULEVARD
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City | LOS ANGELES
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State | CA
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Zip | 90066
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Country | US
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Telephone | 310-980-5788
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Fax | 310-391-7713
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Provider Business Mailing Address
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Address Line | 3437 INGLEWOOD BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90066-1915
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Country | US
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Telephone | 310-980-5788
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Fax | 301-391-7713
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Authorized Official
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Title or Position | PRESIDENT
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Name | SARA LOUISE KOSSUTH
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Credential | DO
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Telephone | 310-980-5788
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 20A5955
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License Number State | CA
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