MEDICARE: ABRAM KOSTENBOYM, MD PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	A38783	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144246208
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABRAM KOSTENBOYM, MD PHD

Provider Business Mailing Address
First Line	:	7855 SANTA MONICA BLVD
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046-5344
Country	:	US
Telephone Number	:	323-656-1082
Fax Number	:	323-656-1083

Provider Business Practice Location Address
First Line	:	7855 SANTA MONICA BLVD
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046-5344
Country	:	US
Telephone Number	:	323-656-1082
Fax Number	:	323-656-1083

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ABRAM KOSTENBOYM
Credential	:	MD
Telephone Number	:	323-656-1082

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	11/20/2009

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