Provider Demographics
NPI:1619069820
Name:HURST, RONALD (MD)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:
Last Name:HURST
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 1:501 EAST HARDY STREET
Mailing Address - Street 2:SUITE 210
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-4504
Mailing Address - Country:US
Mailing Address - Phone:310-673-4900
Mailing Address - Fax:310-673-1319
Practice Address - Street 1:11800 WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-6602
Practice Address - Country:US
Practice Address - Phone:310-231-2121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG76428208600000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0078930OtherMCAL GROUP NUMBER
CAWG76428CMedicare PIN
CAF69117Medicare UPIN