Provider Demographics
NPI:1831308832
Name:HEYMING, THEODORE WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:WILLIAM
Last Name:HEYMING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1626 MALCOLM AVE
Mailing Address - Street 2:203
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-7821
Mailing Address - Country:US
Mailing Address - Phone:310-713-7331
Mailing Address - Fax:310-782-1763
Practice Address - Street 1:1000 W CARSON ST
Practice Address - Street 2:DEPARTMENT OF EMERGENCY MEDICINE
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-2004
Practice Address - Country:US
Practice Address - Phone:310-222-3501
Practice Address - Fax:310-782-1763
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA93062207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine