Healthcare Provider Details

I. General information

NPI: 1760305049
Provider Name (Legal Business Name): WEST VALLEY MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 W MAGNOLIA BLVD
BURBANK CA
91506-1607
US

IV. Provider business mailing address

1020 W MAGNOLIA BLVD
BURBANK CA
91506-1607
US

V. Phone/Fax

Practice location:
  • Phone: 818-478-1031
  • Fax: 818-478-1032
Mailing address:
  • Phone: 818-478-1031
  • Fax: 818-478-1032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY PHAN
Title or Position: CEO
Credential: MD
Phone: 747-367-2348