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General NPI Number Information
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NPI Number | 1225357155
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Entity Type | Organization
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Legal Business Name | RANDY HAWKINS, M.D., INC
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Dates
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Enumeration Date | 05/17/2010
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Last Update Date | 05/17/2010
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Provider Practice Location Address
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Address Line | 644 E REGENT ST #200
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City | INGLEWOOD
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State | CA
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Zip | 90301-1433
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Country | US
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Telephone | 310-674-1970
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Fax | 310-674-7712
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Provider Business Mailing Address
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Address Line | 6709 LA TIJERA BLVD #500
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City | LOS ANGELES
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State | CA
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Zip | 90045-2017
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Country | US
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Telephone | 310-674-1970
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Fax | 310-674-7712
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RANDY HAWKINS
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Credential | M.D.
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Telephone | 310-674-1970
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | G49354
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | G49354
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License Number State | CA
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