Kevin Michael Hadidjaja

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DDS105752 Issued in CA

Practice address

905 E 2ND St Apt 336
Los Angeles, CA 90012-4465

Phone

(310) 347-8432

NPI assigned

Dec 9, 2020

Last updated

Dec 9, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1607472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607472000000",
    "number": "1538765086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "905 E 2ND ST APT 336",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900124465",
            "telephone_number": "310-347-8432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "905 E 2ND ST APT 336",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900124465",
            "telephone_number": "310-347-8432"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HADIDJAJA",
        "first_name": "KEVIN",
        "middle_name": "MICHAEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-12-09",
        "last_updated": "2020-12-09",
        "certification_date": "2020-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "DDS105752",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stefani Elizabeth Haddox, SLP
• Tyson A. Hadduck, M.D.
• Steven M. Haddy, M.D.
• Alexandra Demco Haden, M.D.
• Shahram Hadidchi, MD
• Renee Hadley
• Kelly Hadnott-Brown
• Josephine H Haduong, M.D.
• Sabina Hadziabdulahovic, NP
• Hae Dong Sung Gook Acupuncture Clinic

• General Practice Dentistry in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.