Healthcare Provider Details

I. General information

NPI: 1164706685
Provider Name (Legal Business Name): SHIRIN HEKMAT MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2011
Last Update Date: 10/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9763 W PICO BLVD SUITE 200
LOS ANGELES CA
90035-4748
US

IV. Provider business mailing address

9763 W PICO BLVD SUITE 200
LOS ANGELES CA
90035-4748
US

V. Phone/Fax

Practice location:
  • Phone: 310-712-0000
  • Fax:
Mailing address:
  • Phone: 310-712-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA31680
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberA31680
License Number StateCA

VIII. Authorized Official

Name: SHIRIN HEKMAT
Title or Position: PRESIDENT
Credential: MD
Phone: 310-712-0000