Provider Demographics
NPI:1811067085
Name:HIDAKA, KEN CALVIN (MD)
Entity type:Individual
Prefix:DR
First Name:KEN
Middle Name:CALVIN
Last Name:HIDAKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3418 LOMA VISTA ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93033-3015
Mailing Address - Country:US
Mailing Address - Phone:805-642-8565
Mailing Address - Fax:805-642-8564
Practice Address - Street 1:3525 LOMA VISTA RD
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3101
Practice Address - Country:US
Practice Address - Phone:805-641-6434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG69422207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG69422Medicare ID - Type Unspecified