Healthcare Provider Details

I. General information

NPI: 1790127298
Provider Name (Legal Business Name): JEILA MARIE KAKAVAND PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JEILA KERDAR PA-C

II. Dates (important events)

Enumeration Date: 07/24/2013
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23530 HAWTHORNE BLVD STE 250
TORRANCE CA
90505-4726
US

IV. Provider business mailing address

23530 HAWTHORNE BLVD STE 250
TORRANCE CA
90505-4726
US

V. Phone/Fax

Practice location:
  • Phone: 424-903-7007
  • Fax: 424-903-7009
Mailing address:
  • Phone: 424-903-7007
  • Fax: 424-903-7009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number52220
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: