Healthcare Provider Details

I. General information

NPI: 1659234045
Provider Name (Legal Business Name): VALLEY GLEN MEDICAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13753 VICTORY BLVD.
VAN NUYS CA
91401
US

IV. Provider business mailing address

13753 VICTORY BLVD.
VAN NUYS CA
91401
US

V. Phone/Fax

Practice location:
  • Phone: 818-860-4655
  • Fax: 818-860-4755
Mailing address:
  • Phone: 818-860-4655
  • Fax: 818-860-4755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PARVEZ JESSANI
Title or Position: PRESIDENT
Credential: MD
Phone: 818-860-4655