Provider Demographics
NPI:1972650513
Name:HAYWARD L. EUBANKS, M.D., A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:HAYWARD L. EUBANKS, M.D., A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HAYWARD
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:EUBANKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-679-0676
Mailing Address - Street 1:5529 SECREST DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90043-2029
Mailing Address - Country:US
Mailing Address - Phone:310-679-0676
Mailing Address - Fax:323-296-4776
Practice Address - Street 1:4477 W 118TH ST
Practice Address - Street 2:205
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-2255
Practice Address - Country:US
Practice Address - Phone:310-679-0676
Practice Address - Fax:323-296-4776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG54388207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA93297Medicare UPIN