Healthcare Provider Details

I. General information

NPI: 1033399498
Provider Name (Legal Business Name): UNIVERSAL DIAGNOSTIC MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2007
Last Update Date: 11/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4322 WILSHIRE BLVD STE 303
LOS ANGELES CA
90010-3793
US

IV. Provider business mailing address

11901 SANTA MONICA BLVD 468
LOS ANGELES CA
90025-2767
US

V. Phone/Fax

Practice location:
  • Phone: 310-822-1522
  • Fax: 206-202-4724
Mailing address:
  • Phone: 310-828-1522
  • Fax: 206-202-4724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License NumberG29768
License Number StateCA

VIII. Authorized Official

Name: DR. STEVEN KAYE
Title or Position: CEO
Credential: MD
Phone: 310-828-1522