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Provider Information for 1023293016

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know


Gender: MALE

Individual NPI: 1023293016

Calendar   Last Updated:  2018-02-02
  Certification Date: 


Name Value
NPI 1023293016
Enumeration Date 2008-01-08
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 3130 S HILL ST
LOS ANGELES, CA 90007-3817
United States

Phone: 310-409-6559 | Fax:
View Map External Link
Primary Practice Address 6265 SEPULVEDA BLVD STE 9 & 10
VAN NUYS, CA 91411-1114
United States

Phone: 818-779-0555 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Primary Taxonomy Selected Taxonomy State License Number
Yes 207RG0100X - Internal Medicine Gastroenterology CA A100335
No 207R00000X - Internal Medicine CA A100335
No 208D00000X - General Practice CA A100335