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General NPI Number Information
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NPI Number | 1861811010
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Entity Type | Individual
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Provider Name | MICAH KADDEN
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Gender | Male
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Dates
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Enumeration Date | 04/15/2014
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Last Update Date | 06/09/2021
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Provider Practice Location Address
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Address Line | 200 UCLA MEDICAL PLZ STE 265
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City | LOS ANGELES
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State | CA
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Zip | 90095-2916
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Country | US
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Telephone | 310-825-0867
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Fax | 310-794-5066
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Provider Business Mailing Address
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Address Line | 5767 W CENTURY BLVD STE 400
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City | LOS ANGELES
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State | CA
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Zip | 90045-5631
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Country | US
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Telephone | 310-301-8807
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Fax | 310-301-8751
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD045205
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 2080P0203X
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Taxonomy Name | Pediatric Critical Care Medicine Physician
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License Number | A172649
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License Number State | CA
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