Individual
DR. KENNETH BERTRAM ELCONIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8405 BEVERLY BLVD, LOS ANGELES, CA 90048-3401
(323) 653-8622
(323) 658-6773
Mailing address
500 HOMEWOOD RD, LOS ANGELES, CA 90049-1906
(310) 472-2983
(310) 472-0832
Taxonomy
Speciality
Code
Description
License number
State
261QU0200X
Urgent Care Clinic/Center
Primary
AFE17621
CA
Other
Enumeration date
06/05/2007
Last updated
07/18/2007
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