Provider Demographics
NPI:1386961860
Name:HILLEL LAKS MD INC
Entity type:Organization
Organization Name:HILLEL LAKS MD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:HILLEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LAKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-859-0301
Mailing Address - Street 1:615 N CRESCENT DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-3329
Mailing Address - Country:US
Mailing Address - Phone:310-859-0301
Mailing Address - Fax:310-550-8323
Practice Address - Street 1:615 N CRESCENT DR
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-3329
Practice Address - Country:US
Practice Address - Phone:310-859-0301
Practice Address - Fax:310-550-8323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-23
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37669261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A376669Medicaid
CA00A376669Medicaid