Provider Demographics
NPI:1366742629
Name:HAKHAMIMI, KAMRON KENNETH (MD)
Entity type:Individual
Prefix:
First Name:KAMRON
Middle Name:KENNETH
Last Name:HAKHAMIMI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 40009
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91614-4009
Mailing Address - Country:US
Mailing Address - Phone:323-697-2330
Mailing Address - Fax:
Practice Address - Street 1:191 S BUENA VISTA ST STE 335
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4562
Practice Address - Country:US
Practice Address - Phone:818-561-4733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-02
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA74169207QA0505X, 207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1629525274OtherNPI#2