Healthcare Provider Details

I. General information

NPI: 1043796592
Provider Name (Legal Business Name): KAVYA H MANU MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2018
Last Update Date: 07/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 BEVERLY BLVD
WEST HOLLYWOOD CA
90048-1804
US

IV. Provider business mailing address

PO BOX 833
BEVERLY HILLS CA
90213-0833
US

V. Phone/Fax

Practice location:
  • Phone: 310-423-3277
  • Fax: 661-878-8551
Mailing address:
  • Phone: 661-878-8150
  • Fax: 661-878-8551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA144220
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA144220
License Number StateCA

VIII. Authorized Official

Name: KAVYA H MANU
Title or Position: OWNER / PRESIDENT
Credential: MD
Phone: 310-423-3277