MEDICARE: DIMITRY DEMUR CEO

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	2279P1004X	Pulmonary Diagnostics Registered Respiratory Therapist	TG456	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	TG456	OTHER	CA	PROVIDER

General Provider Information

NPI Number	:	1841240017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIMITRY DEMUR CEO

Provider Business Mailing Address
First Line	:	1345 N KINGSLEY DR
Second Line	:	#116
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-5763
Country	:	US
Telephone Number	:	323-496-6297
Fax Number	:

Provider Business Practice Location Address
First Line	:	3540 WILSHIRE BLVD
Second Line	:	#406
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-2307
Country	:	US
Telephone Number	:	213-389-7188
Fax Number	:	213-389-7198

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

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	07/08/2007

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Directions to “ DIMITRY DEMUR CEO” Practice Location

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