Healthcare Provider Details

I. General information

NPI: 1689636730
Provider Name (Legal Business Name): BURBANK EMERGENCY MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 07/09/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S BUENA VISTA ST EM DEPT
BURBANK CA
91505-4809
US

IV. Provider business mailing address

501 S BUENA VISTA ST
BURBANK CA
91505-4809
US

V. Phone/Fax

Practice location:
  • Phone: 818-843-5111
  • Fax:
Mailing address:
  • Phone: 818-847-4055
  • Fax: 818-848-4320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN EDWARD KISHINEFF
Title or Position: PRESIDENT
Credential: MD
Phone: 818-847-4055