Provider Demographics
NPI:1760580971
Name:HAWKINS, RANDY WENDELL (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:WENDELL
Last Name:HAWKINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:6709 LA TIJERA BLVD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-2017
Mailing Address - Country:US
Mailing Address - Phone:310-674-1970
Mailing Address - Fax:310-674-7041
Practice Address - Street 1:644 E REGENT ST
Practice Address - Street 2:SUITE 200
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-1433
Practice Address - Country:US
Practice Address - Phone:310-674-1970
Practice Address - Fax:310-674-7041
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG49354207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G493540Medicaid
CAG49354Medicare ID - Type Unspecified
CAA51341Medicare UPIN