Healthcare Provider Details

I. General information

NPI: 1780782813
Provider Name (Legal Business Name): LANGVE MEDICAL GROUP,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

638 E COLORADO ST
GLENDALE CA
91205-1710
US

IV. Provider business mailing address

638 E COLORADO ST
GLENDALE CA
91205-1710
US

V. Phone/Fax

Practice location:
  • Phone: 818-507-9800
  • Fax: 818-241-1359
Mailing address:
  • Phone: 818-507-9800
  • Fax: 818-241-1359

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: LEON G PHAM
Title or Position: PRESIDENT
Credential: P.A
Phone: 818-507-9800