Provider Demographics
NPI:1790033116
Name:ANDREW E. HENDIFAR,M.D. A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ANDREW E. HENDIFAR,M.D. A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:E
Authorized Official - Last Name:HENDIFAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-422-8999
Mailing Address - Street 1:464 20TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90402-2434
Mailing Address - Country:US
Mailing Address - Phone:310-422-8999
Mailing Address - Fax:
Practice Address - Street 1:8733 BEVERLY BLVD
Practice Address - Street 2:SUITE 408
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90048-1827
Practice Address - Country:US
Practice Address - Phone:310-933-4470
Practice Address - Fax:310-933-4174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-15
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA88863207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty