Healthcare Provider Details

I. General information

NPI: 1518081652
Provider Name (Legal Business Name): JPB MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 03/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15243 VANOWEN ST STE 406
VAN NUYS CA
91405-3605
US

IV. Provider business mailing address

15243 VANOWEN ST STE 406
VAN NUYS CA
91405-3636
US

V. Phone/Fax

Practice location:
  • Phone: 818-780-2106
  • Fax: 818-780-4271
Mailing address:
  • Phone: 818-780-2106
  • Fax: 818-780-4271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DENISE PHAN
Title or Position: PRESIDENT
Credential: MD
Phone: 818-780-2106