Provider Demographics
NPI:1588871107
Name:HUDDLESTON HIP & KNEE INSTITUTE
Entity type:Organization
Organization Name:HUDDLESTON HIP & KNEE INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:HUDDLESTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-708-9090
Mailing Address - Street 1:5525 ETIWANDA AVE
Mailing Address - Street 2:SUITE 324
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-3647
Mailing Address - Country:US
Mailing Address - Phone:818-708-9090
Mailing Address - Fax:818-708-3901
Practice Address - Street 1:5525 ETIWANDA AVE
Practice Address - Street 2:SUITE 324
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3647
Practice Address - Country:US
Practice Address - Phone:818-708-9090
Practice Address - Fax:818-708-3901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW17865Medicare ID - Type UnspecifiedMEDICARE PROVIDER #