Provider Demographics
NPI:1962436311
Name:ASSIL, KERRY K (MD)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:K
Last Name:ASSIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:450 N. ROXBURY DR. 3RD FL.
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210
Mailing Address - Country:US
Mailing Address - Phone:310-453-8911
Mailing Address - Fax:310-453-2519
Practice Address - Street 1:450 N. ROXBURY DR. 3RD FL.
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210
Practice Address - Country:US
Practice Address - Phone:310-453-8911
Practice Address - Fax:310-453-2519
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG62647207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G626470Medicaid
CAE36018Medicare UPIN
CA00G626470Medicaid