Healthcare Provider Details

I. General information

NPI: 1366742629
Provider Name (Legal Business Name): KAMRON KENNETH HAKHAMIMI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2010
Last Update Date: 08/20/2020
Certification Date: 08/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 S BUENA VISTA ST STE 335
BURBANK CA
91505-4562
US

IV. Provider business mailing address

PO BOX 40009
STUDIO CITY CA
91614-4009
US

V. Phone/Fax

Practice location:
  • Phone: 818-561-4733
  • Fax:
Mailing address:
  • Phone: 323-697-2330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberA74169
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberA74169
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: