Healthcare Provider Details

I. General information

NPI: 1851517148
Provider Name (Legal Business Name): ANDREA HOFFMAN KACHUCK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANDREA RACHEL HOFFMAN M.D.

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 11/14/2018
Certification Date:
Deactivation Date: 10/07/2014
Reactivation Date: 11/14/2018

III. Provider practice location address

4804 LAUREL CANYON BLVD #706
VALLEY VILLAGE CA
91607-3717
US

IV. Provider business mailing address

4804 LAUREL CANYON BLVD #706
VALLEY VILLAGE CA
91607-3717
US

V. Phone/Fax

Practice location:
  • Phone: 818-506-6929
  • Fax:
Mailing address:
  • Phone: 818-506-6929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG060803
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: