Provider Demographics
NPI:1720255953
Name:HASTINGS, CAROL KIM (MA)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:KIM
Last Name:HASTINGS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:KIM
Other - Last Name:HASTINGS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1710 GRANVILLE AVE
Mailing Address - Street 2:UNIT 4
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-7368
Mailing Address - Country:US
Mailing Address - Phone:917-371-2677
Mailing Address - Fax:
Practice Address - Street 1:1710 GRANVILLE AVE
Practice Address - Street 2:UNIT 4
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-7368
Practice Address - Country:US
Practice Address - Phone:917-371-2677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program