Healthcare Provider Details

I. General information

NPI: 1538908108
Provider Name (Legal Business Name): KEBE MD GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2024
Last Update Date: 05/22/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10916 RIVERSIDE DR STE A
TOLUCA LAKE CA
91602-2210
US

IV. Provider business mailing address

10916 RIVERSIDE DR STE A
TOLUCA LAKE CA
91602-2210
US

V. Phone/Fax

Practice location:
  • Phone: 818-435-9060
  • Fax:
Mailing address:
  • Phone: 818-435-9060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: KEVIN BERGER
Title or Position: CEO/OWNER
Credential: MD
Phone: 818-435-9060