Provider Demographics
NPI:1447337779
Name:BURKHART, VIVIAN (NP)
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:
Last Name:BURKHART
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:VIVIAN
Other - Middle Name:
Other - Last Name:LAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 512717
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-0717
Mailing Address - Country:US
Mailing Address - Phone:310-824-0262
Mailing Address - Fax:
Practice Address - Street 1:8700 BEVERLY BLVD # 103
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90048-1804
Practice Address - Country:US
Practice Address - Phone:310-423-3851
Practice Address - Fax:310-423-0246
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP12734363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner