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General NPI Number Information
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NPI Number | 1174856348
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Entity Type | Organization
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Legal Business Name | 101 FAMILY MEDICAL GROUP,A PROFESSIONAL CORP
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Dates
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Enumeration Date | 09/06/2009
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Last Update Date | 04/07/2011
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Provider Practice Location Address
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Address Line | 22030 SHERMAN WAY STE 101
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City | CANOGA PARK
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State | CA
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Zip | 91303-1844
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Country | US
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Telephone | 818-312-9101
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Fax | 818-312-9100
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Provider Business Mailing Address
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Address Line | 7201 ROCKRIDGE TER
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City | WEST HILLS
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State | CA
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Zip | 91307-1265
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Country | US
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Telephone | 818-312-9101
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Fax | 818-312-9100
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. HESSAM AAZAMI
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Credential | M.D
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Telephone | 818-312-9101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | A85704
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License Number State | CA
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