MEDICARE: KAMRON KENNETH HAKHAMIMI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QA0505X	Adult Medicine Physician	A74169	CA
2	207QA0401X	Addiction Medicine (Family Medicine) Physician	A74169	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1629525274	OTHER	CA	NPI#2

General Provider Information

NPI Number	:	1366742629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAMRON KENNETH HAKHAMIMI M.D.

Provider Business Mailing Address
First Line	:	PO BOX 40009
Second Line	:
City	:	STUDIO CITY
State	:	CA
Zip	:	91614-4009
Country	:	US
Telephone Number	:	323-697-2330
Fax Number	:

Provider Business Practice Location Address
First Line	:	191 S BUENA VISTA ST STE 335
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91505-4562
Country	:	US
Telephone Number	:	818-561-4733
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2010
Last Update Date	:	08/20/2020

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