Healthcare Provider Details

I. General information

NPI: 1467159715
Provider Name (Legal Business Name): OEVN MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2023
Last Update Date: 02/07/2023
Certification Date: 02/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13651 OXNARD ST
VAN NUYS CA
91401-4045
US

IV. Provider business mailing address

13651 OXNARD ST
VAN NUYS CA
91401-4045
US

V. Phone/Fax

Practice location:
  • Phone: 818-275-6901
  • Fax:
Mailing address:
  • Phone: 818-275-6901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2081H0002X
TaxonomyHospice and Palliative Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: EUGENE OSTROVSKY
Title or Position: PRESIDENT
Credential: MD
Phone: 818-275-6901