Healthcare Provider Details

I. General information

NPI: 1710913223
Provider Name (Legal Business Name): ALEXANDER RIVKIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1033 GAYLEY AVE
LOS ANGELES CA
90024-3417
US

IV. Provider business mailing address

1033 GAYLEY AVE
LOS ANGELES CA
90024-3417
US

V. Phone/Fax

Practice location:
  • Phone: 310-443-5273
  • Fax: 310-443-3660
Mailing address:
  • Phone: 310-443-5273
  • Fax: 310-443-3660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberA67985
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA67985
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: