Healthcare Provider Details

I. General information

NPI: 1285931105
Provider Name (Legal Business Name): DAVID LAVIAN M.D. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2011
Last Update Date: 02/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14600 SHERMAN WAY SUITE 215
VAN NUYS CA
91405-2283
US

IV. Provider business mailing address

PO BOX 571286
TARZANA CA
91357-1286
US

V. Phone/Fax

Practice location:
  • Phone: 818-782-4300
  • Fax: 818-782-6411
Mailing address:
  • Phone: 818-782-4300
  • Fax: 818-782-6411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA46370
License Number StateCA

VIII. Authorized Official

Name: DR. DAVID LAVIAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 818-782-4300