Provider Demographics
NPI:1710764576
Name:KEVIN J PELTON MD INC
Entity type:Organization
Organization Name:KEVIN J PELTON MD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:JEFFREY
Authorized Official - Last Name:PELTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-264-7600
Mailing Address - Street 1:1700 E CESAR E CHAVEZ AVE STE 2200
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-2476
Mailing Address - Country:US
Mailing Address - Phone:323-264-7600
Mailing Address - Fax:323-261-8027
Practice Address - Street 1:1505 WILSON TER STE 310
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4073
Practice Address - Country:US
Practice Address - Phone:818-877-2248
Practice Address - Fax:818-341-4836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-13
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty