Healthcare Provider Details

I. General information

NPI: 1093637894
Provider Name (Legal Business Name): INNOVATIVE GASTROENTEROLOGY PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8631 W 3RD ST STE 1015
LOS ANGELES CA
90048-5913
US

IV. Provider business mailing address

269 S BEVERLY DR STE 963
BEVERLY HILLS CA
90212-3851
US

V. Phone/Fax

Practice location:
  • Phone: 310-652-4472
  • Fax:
Mailing address:
  • Phone: 310-614-3897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CAMERON SIKAVI
Title or Position: PHYSICIAN, PRACTICE OWNER
Credential: MD
Phone: 310-614-3897