Healthcare Provider Details

I. General information

NPI: 1497865851
Provider Name (Legal Business Name): AVIVA D BIEDERMAN MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8635 W 3RD ST SUITE 260W
LOS ANGELES CA
90048-6101
US

IV. Provider business mailing address

8635 W 3RD ST SUITE 260W
LOS ANGELES CA
90048-6101
US

V. Phone/Fax

Practice location:
  • Phone: 310-652-3324
  • Fax: 310-652-2389
Mailing address:
  • Phone: 310-652-3324
  • Fax: 310-652-2389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA25756
License Number StateCA

VIII. Authorized Official

Name: AVIVA DUNKELMAN BIEDERMAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-652-3324