Healthcare Provider Details

I. General information

NPI: 1023026143
Provider Name (Legal Business Name): THEODORE S. FEIT, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10918 RIVERSIDE DR # A
NORTH HOLLYWOOD CA
91602-2210
US

IV. Provider business mailing address

10918 RIVERSIDE DR # A10918
NORTH HOLLYWOOD CA
91602-2210
US

V. Phone/Fax

Practice location:
  • Phone: 818-636-6463
  • Fax: 818-345-3533
Mailing address:
  • Phone: 818-636-6463
  • Fax: 818-345-3533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG32804
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. THEODORE S. FEIT
Title or Position: PRESIDENT
Credential: M.D.
Phone: 818-843-7462