Provider Demographics
NPI:1750507836
Name:H.KENNETH FISHER,M.D.,INC.
Entity Type:Organization
Organization Name:H.KENNETH FISHER,M.D.,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:GURYANOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-553-0426
Mailing Address - Street 1:9400 BRIGHTON WAY
Mailing Address - Street 2:STE 410
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4712
Mailing Address - Country:US
Mailing Address - Phone:310-553-0426
Mailing Address - Fax:310-274-6083
Practice Address - Street 1:9400 BRIGHTON WAY
Practice Address - Street 2:STE 410
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4712
Practice Address - Country:US
Practice Address - Phone:310-553-0426
Practice Address - Fax:310-274-6083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC28508207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC28508Medicare ID - Type Unspecified
CAA287268Medicare UPIN