Provider Demographics
NPI:1679560320
Name:KADIVAR, HAKIMEH B (MD)
Entity Type:Individual
Prefix:DR
First Name:HAKIMEH
Middle Name:B
Last Name:KADIVAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3440 LOMITA BLVD
Mailing Address - Street 2:242
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4801
Mailing Address - Country:US
Mailing Address - Phone:310-517-8690
Mailing Address - Fax:310-534-2889
Practice Address - Street 1:3440 LOMITA BLVD
Practice Address - Street 2:242
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4801
Practice Address - Country:US
Practice Address - Phone:310-517-8690
Practice Address - Fax:310-534-2889
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32307207Y00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA26757Medicare UPIN
CAA32307Medicare ID - Type Unspecified