Provider Demographics
NPI:1043739345
Name:KATIRAI, ANDREW
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:KATIRAI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5767 W CENTURY BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:757 WESTWOOD PLZ STE 3325
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-7403
Practice Address - Country:US
Practice Address - Phone:310-267-8653
Practice Address - Fax:310-267-3899
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-18
Last Update Date:2024-08-01
Deactivation Date:2020-03-26
Deactivation Code:
Reactivation Date:2020-05-06
Provider Licenses
StateLicense IDTaxonomies
CAA189087207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology