Provider Demographics
NPI:1417930215
Name:HUNTER, CHARLES ARTHUR (MD)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:ARTHUR
Last Name:HUNTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:CHARLES
Other - Middle Name:ARTHUR
Other - Last Name:HUNTER
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1300 N VERMONT AVE
Mailing Address - Street 2:STE 908
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-6094
Mailing Address - Country:US
Mailing Address - Phone:213-484-2000
Mailing Address - Fax:213-484-9716
Practice Address - Street 1:1300 N VERMONT AVE
Practice Address - Street 2:STE 908
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6094
Practice Address - Country:US
Practice Address - Phone:213-484-2000
Practice Address - Fax:213-484-9716
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-25
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG42322208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G423221Medicaid
CAF01047Medicare UPIN
CAG42322AMedicare ID - Type Unspecified