Provider Demographics
NPI:1144513367
Name:KOLTON, DROR (MD)
Entity type:Individual
Prefix:DR
First Name:DROR
Middle Name:
Last Name:KOLTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 N DOHENY DR
Mailing Address - Street 2:#417
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-3172
Mailing Address - Country:US
Mailing Address - Phone:310-248-3654
Mailing Address - Fax:
Practice Address - Street 1:930 N DOHENY DR
Practice Address - Street 2:#417
Practice Address - City:W HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069-3172
Practice Address - Country:US
Practice Address - Phone:760-248-3654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-20
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171100000X
CAC51958207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No171100000XOther Service ProvidersAcupuncturist