Healthcare Provider Details

I. General information

NPI: 1134330673
Provider Name (Legal Business Name): SHER INSTITUTE FOR REPRODUCTIVE MEDICINE LOS ANGELES MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 07/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 E CHEVY CHASE DR SUITE 101
GLENDALE CA
91206-4106
US

IV. Provider business mailing address

5320 S. RAINBOW BLVD SUITE 300
LAS VEGAS NV
89118
US

V. Phone/Fax

Practice location:
  • Phone: 818-291-1985
  • Fax: 818-291-1986
Mailing address:
  • Phone: 702-794-0073
  • Fax: 702-696-0554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number6803906
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number6803906
License Number StateCA

VIII. Authorized Official

Name: AYKUT BAYRAK
Title or Position: MEDICA DIRECTOR
Credential: M.D.
Phone: 818-291-1985