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General NPI Number Information
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NPI Number | 1053550293
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Entity Type | Organization
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Legal Business Name | ENCINO SPORTS MEDICINE GROUP, INC.
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Dates
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Enumeration Date | 02/11/2009
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Last Update Date | 02/11/2009
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Provider Practice Location Address
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Address Line | 16500 VENTURA BLVD 360
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City | ENCINO
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State | CA
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Zip | 91436-2011
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Country | US
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Telephone | 818-986-1210
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Fax | 818-986-1029
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Provider Business Mailing Address
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Address Line | 16500 VENTURA BLVD 360
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City | ENCINO
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State | CA
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Zip | 91436-2011
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Country | US
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Telephone | 818-986-1210
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Fax | 818-986-1029
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Authorized Official
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Title or Position | CEO
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Name | STEVEN KAYE
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Credential | MD
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Telephone | 818-986-1210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | DC28811
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | G7818
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | G29768
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License Number State | CA
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