Healthcare Provider Details

I. General information

NPI: 1902605108
Provider Name (Legal Business Name): STARBRIGHT MEDICAL CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2025
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17071 VENTURA BLVD STE 104
ENCINO CA
91316-4142
US

IV. Provider business mailing address

17071 VENTURA BLVD STE 104
ENCINO CA
91316-4142
US

V. Phone/Fax

Practice location:
  • Phone: 213-852-6006
  • Fax:
Mailing address:
  • Phone: 213-852-6006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: ABDUL RAB KHAN
Title or Position: CEO/OWNER
Credential: MD
Phone: 213-852-6006