Provider Demographics
NPI:1770896169
Name:GOLDMAN, KELLY ERICKSON (MD)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ERICKSON
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:THERESE
Other - Last Name:ERICKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4950 W SUNSET BLVD FL 2
Mailing Address - Street 2:RADIATION ONCOLOGY DEPT
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-5822
Mailing Address - Country:US
Mailing Address - Phone:323-783-2841
Mailing Address - Fax:
Practice Address - Street 1:4950 W SUNSET BLVD FL 2
Practice Address - Street 2:RADIATION ONCOLOGY DEPT
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-5822
Practice Address - Country:US
Practice Address - Phone:323-783-2841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-14
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program