Healthcare Provider Details

I. General information

NPI: 1669425542
Provider Name (Legal Business Name): ED FIK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 09/06/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16111 PLUMMER ST
SEPULVEDA CA
91343-2036
US

IV. Provider business mailing address

15823 WARM SPRINGS DR
CANYON COUNTRY CA
91387-4032
US

V. Phone/Fax

Practice location:
  • Phone: 800-516-4567
  • Fax: 818-895-9588
Mailing address:
  • Phone: 800-516-4567
  • Fax: 818-895-9588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG28203
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: