Provider Demographics
NPI:1285720680
Name:KOLIN, TALIA (MD)
Entity type:Individual
Prefix:
First Name:TALIA
Middle Name:
Last Name:KOLIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10842 PORTOFINO PL
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077-2301
Mailing Address - Country:US
Mailing Address - Phone:323-262-3333
Mailing Address - Fax:323-262-3528
Practice Address - Street 1:4036 WHITTIER BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90023-2560
Practice Address - Country:US
Practice Address - Phone:323-262-3333
Practice Address - Fax:323-262-3333
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG64713207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G647131Medicaid
CAE87181Medicare UPIN