Healthcare Provider Details

I. General information

NPI: 1821265273
Provider Name (Legal Business Name): DUR HINIKA SURGICAL, A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 05/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5141 CRENSHAW BLVD
LOS ANGELES CA
90043-1853
US

IV. Provider business mailing address

5141 CRENSHAW BLVD
LOS ANGELES CA
90043-1853
US

V. Phone/Fax

Practice location:
  • Phone: 323-545-9288
  • Fax: 323-545-9287
Mailing address:
  • Phone: 323-545-9288
  • Fax: 323-545-9287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberA63029
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA63029
License Number StateCA

VIII. Authorized Official

Name: GUDATA HINIKA
Title or Position: OWNER
Credential: MD
Phone: 323-545-9288