Healthcare Provider Details

I. General information

NPI: 1639435472
Provider Name (Legal Business Name): KIKI L. HURT MD ANESTHESIA AND INTENSIVIST PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2012
Last Update Date: 04/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 S ROBERTSON BLVD
BEVERLY HILLS CA
90211-2811
US

IV. Provider business mailing address

PO BOX 4331
INGLEWOOD CA
90309-4331
US

V. Phone/Fax

Practice location:
  • Phone: 310-551-0690
  • Fax:
Mailing address:
  • Phone: 424-206-1919
  • Fax: 310-303-7944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA96718
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA96718
License Number StateCA

VIII. Authorized Official

Name: MARIA A. APODACA
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 424-206-1919