Individual
AMY M KUSSKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1223 16TH ST STE 3100, SANTA MONICA, CA 90404-1275
(424) 259-8791
(424) 899-7557
Mailing address
5767 W CENTURY BLVD STE 400, LOS ANGELES, CA 90045-5631
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
G78872
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G788720
MEDI-CAL PPIN #
CA
Enumeration date
01/06/2006
Last updated
12/26/2019
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