MEDICARE: DOUGLAS B TAMKIN MD INC

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	G12583	CA

General Provider Information

NPI Number	:	1396915682
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOUGLAS B TAMKIN MD INC

Provider Business Mailing Address
First Line	:	6200 WILSHIRE BLVD STE 1206
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5813
Country	:	US
Telephone Number	:	323-939-2111
Fax Number	:	323-965-8640

Provider Business Practice Location Address
First Line	:	6200 WILSHIRE BLVD STE 1206
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5813
Country	:	US
Telephone Number	:	323-939-2111
Fax Number	:	323-965-8640

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DOUGLAS B TAMKIN
Credential	:	M.D.
Telephone Number	:	323-939-2111

Provider Enumeration Date	:	03/03/2008
Last Update Date	:	03/03/2008

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