Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | E2279 | CA |
Y | 222Z00000X | Podiatrist | E2279 | CA |
NPI | 1063490738 |
---|---|
Provider Name | Dr. Charles Abraham Kelman |
First Address | Santa Monica, CA 90403-5742 |
Second Address | Westlake Village, CA 91361 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2006 |
Last Update Date | 19/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
953499550 | TAX ID (01) | |
GR0000440 | (05) | CA |
T11256 | (02) | CA |