Provider Demographics
NPI:1982403937
Name:PODKOLZIN, DIMITRY
Entity type:Individual
Prefix:
First Name:DIMITRY
Middle Name:
Last Name:PODKOLZIN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10630 KURT ST
Mailing Address - Street 2:
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-6807
Mailing Address - Country:US
Mailing Address - Phone:818-731-5328
Mailing Address - Fax:
Practice Address - Street 1:10630 KURT ST
Practice Address - Street 2:
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-6807
Practice Address - Country:US
Practice Address - Phone:818-731-5328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter