Healthcare Provider Details

I. General information

NPI: 1952627911
Provider Name (Legal Business Name): WALAVAN SIVAKUMAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2010
Last Update Date: 04/20/2021
Certification Date: 04/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5215 TORRANCE BLVD STE 300
TORRANCE CA
90503-4009
US

IV. Provider business mailing address

4718 HERMANO DR
TARZANA CA
91356-4516
US

V. Phone/Fax

Practice location:
  • Phone: 424-212-5361
  • Fax: 310-316-3466
Mailing address:
  • Phone: 818-599-3570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberA135375
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: