Provider Demographics
NPI:1942221072
Name:KIVOWITZ, CHARLES F (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:F
Last Name:KIVOWITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 N ROXBURY DR STE 300
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-5005
Mailing Address - Country:US
Mailing Address - Phone:310-273-7430
Mailing Address - Fax:310-278-5765
Practice Address - Street 1:435 N ROXBURY DR STE 300
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-5005
Practice Address - Country:US
Practice Address - Phone:310-273-7430
Practice Address - Fax:310-278-5765
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYG16910207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA39946Medicare UPIN
CAG16910Medicare ID - Type Unspecified