MEDICARE: PETER P. KOENIG, M.D., INCORPORATED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	A23943	CA
2	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	A23943	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1063462521	OTHER	CA	NPI

General Provider Information

NPI Number	:	1063462521
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PETER P. KOENIG, M.D., INCORPORATED

Provider Business Mailing Address
First Line	:	4940 VAN NUYS BLVD.
Second Line	:	SUITE 200
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91403-1741
Country	:	US
Telephone Number	:	818-528-1222
Fax Number	:	828-528-1225

Provider Business Practice Location Address
First Line	:	4940 VAN NUYS BLVD.
Second Line	:	SUITE 200
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91403-1741
Country	:	US
Telephone Number	:	818-528-1222
Fax Number	:	828-528-1225

Authorized Official
Title or Position	:	5 PERCET OR MORE OWNERSHIP INTEREST
Name	:	DR. PETER P KOENIG
Credential	:	M.D.
Telephone Number	:	818-528-1222

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	01/11/2011

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