Healthcare Provider Details

I. General information

NPI: 1609754183
Provider Name (Legal Business Name): FORWARD UROLOGY MEDICAL GROUP APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2025
Last Update Date: 08/23/2025
Certification Date: 08/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2625 W ALAMEDA AVE STE 400
BURBANK CA
91505-4817
US

IV. Provider business mailing address

12922 VICTORY BLVD STE B
NORTH HOLLYWOOD CA
91606-2924
US

V. Phone/Fax

Practice location:
  • Phone: 818-841-6055
  • Fax: 818-841-1082
Mailing address:
  • Phone: 818-760-2800
  • Fax: 818-760-7343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: NATARAJ CHANDRASEKHAR
Title or Position: MANAGER
Credential:
Phone: 818-760-2800