Provider Demographics
NPI:1467486050
Name:KIHICZAK, DANYLO (MD)
Entity Type:Individual
Prefix:
First Name:DANYLO
Middle Name:
Last Name:KIHICZAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 COTNER AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-3303
Mailing Address - Country:US
Mailing Address - Phone:310-445-2951
Mailing Address - Fax:310-479-1459
Practice Address - Street 1:1516 COTNER AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-3303
Practice Address - Country:US
Practice Address - Phone:310-445-2951
Practice Address - Fax:310-479-1459
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG844222085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G844220OtherBLUE SHIELD
CAGR0106039Medicaid
CA00G844220Medicaid
CATP051AMedicare PIN
CAWG84422JMedicare PIN
CAGR0106039Medicaid
CAWG84422MMedicare PIN
CA00G844221Medicare PIN
CAG93626Medicare UPIN
CA00G844220OtherBLUE SHIELD
CA00G844220Medicare PIN