Basic Information
| Provider Information | |||||||||
| NPI: | 1043739345 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KATIRAI | ||||||||
| FirstName: | ANDREW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 757 WESTWOOD PLAZA, SUITE 3304 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900957403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3102678654 | ||||||||
| FaxNumber: | 3102673766 | ||||||||
| Practice Location | |||||||||
| Address1: | 757 WESTWOOD PLAZA, SUITE 3304 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900957403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3102678654 | ||||||||
| FaxNumber: | 3102673766 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2017 | ||||||||
| LastUpdateDate: | 06/03/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 03/26/2020 | ||||||||
| NPIReactivationDate: | 05/06/2020 | ||||||||
| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 1043739345 | CA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.