Healthcare Provider Details

I. General information

NPI: 1184537441
Provider Name (Legal Business Name): MEDGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10025 SULLY DR
SUN VALLEY CA
91352-4270
US

IV. Provider business mailing address

10025 SULLY DR
SUN VALLEY CA
91352-4270
US

V. Phone/Fax

Practice location:
  • Phone: 818-200-2400
  • Fax: 818-450-0580
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ANNIE KAZAROVA
Title or Position: OWNER
Credential:
Phone: 818-200-2400