MEDICARE: HKLA NEUROPAIN

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	2084N0400X	Neurology Physician

General Provider Information

NPI Number	:	1427604065
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HKLA NEUROPAIN

Provider Business Mailing Address
First Line	:	2204 S BENTLEY AVE APT 104
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-5501
Country	:	US
Telephone Number	:	248-933-0323
Fax Number	:	661-288-7903

Provider Business Practice Location Address
First Line	:	2204 S BENTLEY AVE APT 104
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-5501
Country	:	US
Telephone Number	:	248-933-0323
Fax Number	:	661-288-7903

Authorized Official
Title or Position	:	MEDICAL DIRECTOR / OWNER
Name	:	HIRSH KAVEESHVAR
Credential	:	DO
Telephone Number	:	248-933-0323

Provider Enumeration Date	:	08/09/2019
Last Update Date	:	08/09/2019

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Directions to “HKLA NEUROPAIN ” Practice Location

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