MEDICARE: HAZEL MCKILLOP MD

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	207RP1001X	Pulmonary Disease Physician	A50837	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396766994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAZEL MCKILLOP MD

Provider Business Mailing Address
First Line	:	P.O. BOX 2199
Second Line	:	1455 W REDONDO BLVD
City	:	GARDENA
State	:	CA
Zip	:	90247
Country	:	US
Telephone Number	:	310-370-5888
Fax Number	:

Provider Business Practice Location Address
First Line	:	12900 AVALON BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90061-2734
Country	:	US
Telephone Number	:	310-370-5888
Fax Number	:

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

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	08/19/2015

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