Provider Demographics
NPI:1639435472
Name:KIKI L. HURT MD ANESTHESIA AND INTENSIVIST PC
Entity Type:Organization
Organization Name:KIKI L. HURT MD ANESTHESIA AND INTENSIVIST PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:APODACA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:424-206-1919
Mailing Address - Street 1:PO BOX 4331
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90309-4331
Mailing Address - Country:US
Mailing Address - Phone:424-206-1919
Mailing Address - Fax:310-303-7944
Practice Address - Street 1:220 S ROBERTSON BLVD
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2811
Practice Address - Country:US
Practice Address - Phone:310-551-0690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA96718207L00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty