Healthcare Provider Details

I. General information

NPI: 1285817197
Provider Name (Legal Business Name): CITY DIAGNOSTIC MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2007
Last Update Date: 03/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20301 VENTURA BLVD 115
WOODLAND HILLS CA
91364-2447
US

IV. Provider business mailing address

22631 PACIFIC COAST HWY #441
MALIBU CA
90265-5036
US

V. Phone/Fax

Practice location:
  • Phone: 818-992-1801
  • Fax: 206-202-4724
Mailing address:
  • Phone: 310-871-3434
  • Fax: 206-202-4724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License NumberG029768
License Number StateCA

VIII. Authorized Official

Name: STEVEN KAYE
Title or Position: CEO
Credential: MD
Phone: 310-871-3434