Provider Demographics
NPI:1730592098
Name:KHRIST KAKOSIMIDI
Entity type:Organization
Organization Name:KHRIST KAKOSIMIDI
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KHRIST
Authorized Official - Middle Name:
Authorized Official - Last Name:KAKOSIMIDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-760-2156
Mailing Address - Street 1:12154 HAMLIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-1409
Mailing Address - Country:US
Mailing Address - Phone:818-760-2156
Mailing Address - Fax:818-942-7059
Practice Address - Street 1:12154 HAMLIN ST
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-1409
Practice Address - Country:US
Practice Address - Phone:818-760-2156
Practice Address - Fax:818-942-7059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-04
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45059332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5701660001Medicare NSC