Healthcare Provider Details

I. General information

NPI: 1205220415
Provider Name (Legal Business Name): CHARLE F KIVOWITZ MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2015
Last Update Date: 08/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 N ROXBURY DR SUITE 300
BEVERLY HILLS CA
90210-5027
US

IV. Provider business mailing address

435 N ROXBURY DR SUITE 300
BEVERLY HILLS CA
90210-5027
US

V. Phone/Fax

Practice location:
  • Phone: 310-273-7430
  • Fax:
Mailing address:
  • Phone: 310-273-7430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberG16910
License Number StateCA

VIII. Authorized Official

Name: MS. MARGARET UNDERWOOD
Title or Position: OFFICE MANAGER
Credential:
Phone: 310-273-7430