Healthcare Provider Details

I. General information

NPI: 1063994531
Provider Name (Legal Business Name): IAN ROY MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2018
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 S TOPANGA CANYON BLVD STE 103
TOPANGA CA
90290-3154
US

IV. Provider business mailing address

PO BOX 69796
WEST HOLLYWOOD CA
90069-0796
US

V. Phone/Fax

Practice location:
  • Phone: 310-455-2019
  • Fax: 310-455-2010
Mailing address:
  • Phone: 661-878-8150
  • Fax: 661-878-8551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA148748
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA148748
License Number StateCA

VIII. Authorized Official

Name: IAN D ROY
Title or Position: OWNER/PRESIDENT
Credential: MD
Phone: 310-691-9101