Provider Demographics
NPI:1306075379
Name:HIEMENZ, MATTHEW CHARLES (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:CHARLES
Last Name:HIEMENZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3701 WILSHIRE BLVD
Mailing Address - Street 2:STE 600
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-2804
Mailing Address - Country:US
Mailing Address - Phone:323-361-2337
Mailing Address - Fax:323-361-8491
Practice Address - Street 1:4650 W SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6062
Practice Address - Country:US
Practice Address - Phone:323-361-4100
Practice Address - Fax:323-361-3642
Is Sole Proprietor?:No
Enumeration Date:2009-07-10
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA143394207ZP0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0007XAllopathic & Osteopathic PhysiciansPathologyMolecular Genetic Pathology