Healthcare Provider Details

I. General information

NPI: 1609188796
Provider Name (Legal Business Name): THE HEART MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2010
Last Update Date: 07/19/2023
Certification Date: 07/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16320 ROSCOE BLVD STE 100
VAN NUYS CA
91406-1216
US

IV. Provider business mailing address

16320 ROSCOE BLVD STE 100
VAN NUYS CA
91406-1216
US

V. Phone/Fax

Practice location:
  • Phone: 818-904-6782
  • Fax: 818-904-5896
Mailing address:
  • Phone: 818-908-8048
  • Fax: 818-908-8072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberG77802
License Number StateCA

VIII. Authorized Official

Name: MUNAF A. SHAMJI
Title or Position: PARTNER
Credential: M.D.
Phone: 818-904-6782