MEDICARE: GUS KALIOUNDJI 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	207Q00000X	Family Medicine Physician	A89365	CA
2	207QH0002X	Hospice and Palliative Medicine (Family Medicine) Physician	A89365	CA

General Provider Information

NPI Number	:	1750500609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GUS KALIOUNDJI M.D.

Provider Business Mailing Address
First Line	:	133 S OAKHURST DR
Second Line	:	#303
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90212-3518
Country	:	US
Telephone Number	:	310-278-0530
Fax Number	:	818-887-4222

Provider Business Practice Location Address
First Line	:	133 S OAKHURST DR
Second Line	:	#303
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90212-3518
Country	:	US
Telephone Number	:	310-278-0530
Fax Number	:	818-887-4222

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

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	12/07/2021

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