Healthcare Provider Details

I. General information

NPI: 1629016373
Provider Name (Legal Business Name): NMA MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5525 ETIWANDA AVE 305
TARZANA CA
91356-3647
US

IV. Provider business mailing address

5525 ETIWANDA AVE 305
TARZANA CA
91356-3647
US

V. Phone/Fax

Practice location:
  • Phone: 818-705-7212
  • Fax: 818-705-7215
Mailing address:
  • Phone: 818-705-7212
  • Fax: 818-705-7215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. KENNETH S KLEINMAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 818-705-7212