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General NPI Number Information
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NPI Number | 1023097631
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Entity Type | Organization
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Legal Business Name | CANON MEDICAL GROUP INC
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Dates
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Enumeration Date | 01/11/2006
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Last Update Date | 12/17/2015
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Provider Practice Location Address
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Address Line | 414 N CAMDEN DR SUITE 775
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City | BEVERLY HILLS
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State | CA
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Zip | 90210-4532
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Country | US
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Telephone | 310-274-7300
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Fax | 310-274-7301
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Provider Business Mailing Address
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Address Line | 9777 WILSHIRE BLVD STE 512
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City | BEVERLY HILLS
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State | CA
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Zip | 90212-1905
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Country | US
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Telephone | 310-967-3300
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Fax | 310-967-3377
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. BERNARD SALICK
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Credential | M.D.,
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Telephone | 310-274-3400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | W7122
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License Number State | CA
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