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NPI Code Detail

MEDICARE: DR. DAVID B AGUS M.D.

MEDICARE: DR. DAVID B AGUS M.D.
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
1174400000XSpecialistG85631CA
2207RX0202XMedical Oncology PhysicianG85631CA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3W18762OTHERCAGROUP MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11902846306OTHERCAGROUP NPI
2GR0100430OTHERCAGROUP MEDICAL

General Provider Information

NPI Number : 1356328249
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAVID B AGUS M.D.
Provider Business Mailing Address
First Line : 12414 EXPOSITION BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90064-1016
Country : US
Telephone Number : 310-272-7650
Fax Number :
Provider Business Practice Location Address
First Line : 12414 EXPOSITION BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90064-1016
Country : US
Telephone Number : 310-272-7640
Fax Number : 310-272-7656
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/30/2005
Last Update Date : 06/15/2022

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Directions to “ DR. DAVID B AGUS M.D.” Practice Location

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