Provider Demographics
NPI:1952627911
Name:SIVAKUMAR, WALAVAN (MD)
Entity Type:Individual
Prefix:DR
First Name:WALAVAN
Middle Name:
Last Name:SIVAKUMAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4718 HERMANO DR
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-4516
Mailing Address - Country:US
Mailing Address - Phone:818-599-3570
Mailing Address - Fax:
Practice Address - Street 1:5215 TORRANCE BLVD STE 300
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4009
Practice Address - Country:US
Practice Address - Phone:424-212-5361
Practice Address - Fax:310-316-3466
Is Sole Proprietor?:No
Enumeration Date:2010-04-15
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA135375207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery