Healthcare Provider Details

I. General information

NPI: 1225357155
Provider Name (Legal Business Name): RANDY HAWKINS, M.D., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2010
Last Update Date: 05/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

644 E REGENT ST #200
INGLEWOOD CA
90301-1433
US

IV. Provider business mailing address

6709 LA TIJERA BLVD #500
LOS ANGELES CA
90045-2017
US

V. Phone/Fax

Practice location:
  • Phone: 310-674-1970
  • Fax: 310-674-7712
Mailing address:
  • Phone: 310-674-1970
  • Fax: 310-674-7712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG49354
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberG49354
License Number StateCA

VIII. Authorized Official

Name: DR. RANDY HAWKINS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-674-1970