Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | A133110 | CA |
Y | 207QA0401X | Family Doctor - Addiction Medicine | A133110 | CA |
NPI | 1073856845 |
---|---|
Provider Name | Abraham Malkin |
First Address | Los Angeles, CA 90049-5394 |
Second Address | Malibu, CA 90265-4825 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2013 |
Last Update Date | 06/02/2019 |