Healthcare Provider Details

I. General information

NPI: 1548777865
Provider Name (Legal Business Name): KINDERWUNSCHZENTRUM LOS ANGELES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2018
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18370 BURBANK BLVD STE 511
TARZANA CA
91356-2838
US

IV. Provider business mailing address

18370 BURBANK BLVD STE 511
TARZANA CA
91356-2838
US

V. Phone/Fax

Practice location:
  • Phone: 818-344-8522
  • Fax: 818-344-8521
Mailing address:
  • Phone: 818-344-8522
  • Fax: 818-344-8521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA0006X
TaxonomyAmbulatory Fertility Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VUK JOVANOVIC
Title or Position: ADMINISTRATOR
Credential: MD
Phone: 818-344-8522