Provider Demographics
NPI:1407906050
Name:KERENDIAN-HAKIMI, ANITA (OD)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:KERENDIAN-HAKIMI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5366 W PICO BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-4036
Mailing Address - Country:US
Mailing Address - Phone:323-454-8454
Mailing Address - Fax:
Practice Address - Street 1:5366 W PICO BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-4036
Practice Address - Country:US
Practice Address - Phone:323-454-8454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA10532T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3690739Medicaid
CA3690739Medicaid