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General NPI Number Information
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NPI Number | 1063199255
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Entity Type | Organization
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Legal Business Name | TARZANA OPTIMAL MEDICAL CENTER INC
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Dates
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Enumeration Date | 06/29/2023
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Last Update Date | 06/29/2023
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Provider Practice Location Address
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Address Line | 18345 VENTURA BLVD STE 202
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City | TARZANA
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State | CA
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Zip | 91356-4241
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Country | US
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Telephone | 310-962-9996
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Fax | 747-588-5950
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Provider Business Mailing Address
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Address Line | 18345 VENTURA BLVD STE 202
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City | TARZANA
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State | CA
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Zip | 91356-4241
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Country | US
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Telephone | 310-962-9996
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Fax | 747-588-5950
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Authorized Official
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Title or Position | CEO/
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Name | KEVIN DO
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Credential | MD
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Telephone | 310-962-9996
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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