Healthcare Provider Details

I. General information

NPI: 1619069820
Provider Name (Legal Business Name): RONALD HURST M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 09/21/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11800 WILSHIRE BLVD
LOS ANGELES CA
90025-6602
US

IV. Provider business mailing address

501 EAST HARDY STREET SUITE 210
INGLEWOOD CA
90301-4504
US

V. Phone/Fax

Practice location:
  • Phone: 310-231-2121
  • Fax:
Mailing address:
  • Phone: 310-673-4900
  • Fax: 310-673-1319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberG76428
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberG76428
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: