Healthcare Provider Details

I. General information

NPI: 1205167376
Provider Name (Legal Business Name): OAKDALE ONLY CHOICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2010
Last Update Date: 09/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 VAN NUYS BLVD # 201
VAN NUYS CA
91405-3063
US

IV. Provider business mailing address

7100 VAN NUYS BLVD # 201
VAN NUYS CA
91405-3063
US

V. Phone/Fax

Practice location:
  • Phone: 818-259-9160
  • Fax: 818-942-6091
Mailing address:
  • Phone: 818-259-9160
  • Fax: 818-942-6091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: KENNETH THOMAS
Title or Position: PRESIDENT
Credential:
Phone: 818-259-9160