Genesis Functional Restoration Clinic Inc

Primary specialty

Addiction Medicine (Family Medicine) PhysicianTaxonomy code 207QA0401X

Legal business name

GENESIS FUNCTIONAL RESTORATION CLINIC INC

Practice address

191 S Buena Vista St
335
Burbank, CA 91505-4554

Phone

(323) 697-2330

NPI assigned

Jan 9, 2017

Organization subpart

No

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

Authorized official

Name

Dr. Kamron Kenneth Hakhamimi, M.D.

Title

Medical Director

Phone

(323) 697-2330

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1483920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1483920000000",
    "number": "1912443490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "191 S BUENA VISTA ST",
            "address_2": "335",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "915054554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "191 S BUENA VISTA ST",
            "address_2": "335",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "915054554",
            "telephone_number": "323-697-2330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS FUNCTIONAL RESTORATION CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-09",
        "last_updated": "2017-01-09",
        "status": "A",
        "authorized_official_last_name": "HAKHAMIMI",
        "authorized_official_first_name": "KAMRON",
        "authorized_official_middle_name": "KENNETH",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "323-697-2330",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207QA0401X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Addiction Medicine (Family Medicine) Physician in Burbank, CA
• Providers in Burbank, CA by specialty
• Addiction Medicine (Family Medicine) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2017; 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.