Provider Demographics
NPI:1144278938
Name:KROCHMAL, ROBERT P (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:P
Last Name:KROCHMAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5823 YORK BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042-2634
Mailing Address - Country:US
Mailing Address - Phone:323-255-5643
Mailing Address - Fax:323-254-2158
Practice Address - Street 1:1701 E CESAR CHAVEZ AVE
Practice Address - Street 2:SUITE 402
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-2464
Practice Address - Country:US
Practice Address - Phone:323-317-9200
Practice Address - Fax:323-317-9206
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2007-10-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA73623207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A736230OtherBLUE SHIELD
CA00A736230Medicaid
GAP00197269OtherMEDICARE RAILROAD
CA00A736230Medicaid
CAH66032Medicare UPIN