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General NPI Number Information
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NPI Number | 1629279187
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Entity Type | Organization
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Legal Business Name | DAVID HESKIAOFF MD A PROFESSIONAL CORP
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Dates
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Enumeration Date | 05/30/2007
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Last Update Date | 02/28/2013
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Provider Practice Location Address
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Address Line | 5170 SEPULVEDA BLVD #100
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City | SHERMAN OAKS
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State | CA
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Zip | 91403-1171
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Country | US
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Telephone | 818-784-3878
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Fax |
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Provider Business Mailing Address
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Address Line | 5170 SEPULVEDA BLVD #100
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City | SHERMAN OAKS
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State | CA
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Zip | 91403-1171
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Country | US
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Telephone | 818-784-3878
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Fax |
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Authorized Official
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Title or Position | ASSISTANT CONTROLLER
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Name | GINA KIA
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Credential |
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Telephone | 818-784-3878
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State | CA
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