Individual
AKI LO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1420 S CENTRAL AVE, GLENDALE, CA 91204-2508
(818) 838-4587
Mailing address
PO BOX 35380, LAS VEGAS, NV 89133-5380
(702) 579-3203
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
ME92700
FL
208M00000X
Hospitalist Physician
Primary
A63413
CA
208M00000X
Hospitalist Physician
ME92700
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A63413
STATE MEDICAL LICENSE
CA
01
—
ME92700
ME92700
FL
Enumeration date
10/30/2007
Last updated
12/30/2025
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