Healthcare Provider Details

I. General information

NPI: 1346733367
Provider Name (Legal Business Name): PHILIP K. FRYKMAN, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2018
Last Update Date: 03/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2190 LYNN RD STE 200
THOUSAND OAKS CA
91360-8020
US

IV. Provider business mailing address

PO BOX 6284
MALIBU CA
90264-6284
US

V. Phone/Fax

Practice location:
  • Phone: 805-372-8500
  • Fax: 805-906-7812
Mailing address:
  • Phone: 805-372-8500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License NumberA87814
License Number StateCA

VIII. Authorized Official

Name: PHILIP KENT FRYKMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 310-429-3560