Healthcare Provider Details

I. General information

NPI: 1740119098
Provider Name (Legal Business Name): SSO MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14550 ARCHWOOD ST STE 103
VAN NUYS CA
91405-4604
US

IV. Provider business mailing address

14550 ARCHWOOD ST STE 103
VAN NUYS CA
91405-4604
US

V. Phone/Fax

Practice location:
  • Phone: 310-503-9782
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. STANLEY OLENICK
Title or Position: MD
Credential: MD
Phone: 310-503-9782