Healthcare Provider Details

I. General information

NPI: 1811067085
Provider Name (Legal Business Name): KEN CALVIN HIDAKA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 10/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525 LOMA VISTA RD
VENTURA CA
93003-3101
US

IV. Provider business mailing address

3418 LOMA VISTA ROAD SUITE A
VENTURA CA
93033-3015
US

V. Phone/Fax

Practice location:
  • Phone: 805-641-6434
  • Fax:
Mailing address:
  • Phone: 805-642-8565
  • Fax: 805-642-8564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG69422
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: