Provider Demographics
NPI:1306015847
Name:HAKIMEH B KADIVAR MD INC
Entity Type:Organization
Organization Name:HAKIMEH B KADIVAR MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HAKIMEH
Authorized Official - Middle Name:B
Authorized Official - Last Name:KADIVAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-517-8690
Mailing Address - Street 1:3440 LOMITA BLVD STE 242
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4815
Mailing Address - Country:US
Mailing Address - Phone:310-517-8690
Mailing Address - Fax:310-534-2889
Practice Address - Street 1:3440 LOMITA BLVD STE 242
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4815
Practice Address - Country:US
Practice Address - Phone:310-517-8690
Practice Address - Fax:310-534-2889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Y00000X
CAA32307174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA26757Medicare UPIN
CAA32307Medicare PIN