Provider Demographics
NPI:1821265273
Name:DUR HINIKA SURGICAL, A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:DUR HINIKA SURGICAL, A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GUDATA
Authorized Official - Middle Name:
Authorized Official - Last Name:HINIKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-545-9288
Mailing Address - Street 1:5141 CRENSHAW BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90043-1853
Mailing Address - Country:US
Mailing Address - Phone:323-545-9288
Mailing Address - Fax:323-545-9287
Practice Address - Street 1:5141 CRENSHAW BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90043-1853
Practice Address - Country:US
Practice Address - Phone:323-545-9288
Practice Address - Fax:323-545-9287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA63029208600000X, 2086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma SurgeryGroup - Multi-Specialty