Healthcare Provider Details

I. General information

NPI: 1912836420
Provider Name (Legal Business Name): LOS ANGELES DEVELOPMENTAL BEHAVIORAL PEDIATRIC MEDICAL GROUP, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5955 LANKERSHIM BLVD
NORTH HOLLYWOOD CA
91601-1006
US

IV. Provider business mailing address

PO BOX 6098
BURBANK CA
91510-6098
US

V. Phone/Fax

Practice location:
  • Phone: 818-445-8037
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: SAIRAM KUMAR
Title or Position: MEDICAL DIRECTOR
Credential:
Phone: 818-445-8037