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General NPI Number Information
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NPI Number | 1902058928
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Entity Type | Individual
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Provider Name | KULIN TANTOD MD
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Gender | Male
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Dates
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Enumeration Date | 10/21/2008
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Last Update Date | 05/03/2012
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Provider Practice Location Address
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Address Line | 10039 VINE ST STE A
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City | LAKESIDE
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State | CA
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Zip | 92040-3122
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Country | US
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Telephone | 619-390-9975
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Fax |
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Provider Business Mailing Address
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Address Line | 425 N DATE ST
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City | ESCONDIDO
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State | CA
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Zip | 92025-3413
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Country | US
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Telephone | 760-737-6936
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A109655
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License Number State | CA
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