Healthcare Provider Details

I. General information

NPI: 1679343172
Provider Name (Legal Business Name): ABDY GENE LANG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2024
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10515 BALBOA BLVD STE 140
GRANADA HILLS CA
91344-6350
US

IV. Provider business mailing address

1540 ALCAZAR ST STE 155
LOS ANGELES CA
90089-1029
US

V. Phone/Fax

Practice location:
  • Phone: 181-836-3033
  • Fax:
Mailing address:
  • Phone: 323-442-2900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number305432
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: