MEDICARE: DR. DOLORES RUTH KENT 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
1	174400000X	Specialist	G35258	CA

General Provider Information

NPI Number	:	1366405276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOLORES RUTH KENT M.D.

Provider Business Mailing Address
First Line	:	9201 SUNSET BLVD
Second Line	:	SUITE 406
City	:	LOS ANGELES
State	:	CA
Zip	:	90069
Country	:	US
Telephone Number	:	310-860-9490
Fax Number	:	310-859-7792

Provider Business Practice Location Address
First Line	:	9201 W SUNSET BLVD
Second Line	:	SUITE 406
City	:	LOS ANGELES
State	:	CA
Zip	:	90069-3701
Country	:	US
Telephone Number	:	310-860-9490
Fax Number	:	310-859-7792

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2006
Last Update Date	:	07/08/2007

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