Provider Demographics
NPI:1851517148
Name:KACHUCK, ANDREA HOFFMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:HOFFMAN
Last Name:KACHUCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:RACHEL
Other - Last Name:HOFFMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4804 LAUREL CANYON BLVD
Mailing Address - Street 2:#706
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-3717
Mailing Address - Country:US
Mailing Address - Phone:818-506-6929
Mailing Address - Fax:
Practice Address - Street 1:4804 LAUREL CANYON BLVD
Practice Address - Street 2:#706
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-3717
Practice Address - Country:US
Practice Address - Phone:818-506-6929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2018-11-14
Deactivation Date:2014-10-07
Deactivation Code:
Reactivation Date:2018-11-14
Provider Licenses
StateLicense IDTaxonomies
CAG060803208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics