=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285931105
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAVID LAVIAN M.D. INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2011
-----------------------------------------------------
Last Update Date | 02/13/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14600 SHERMAN WAY SUITE 215
-----------------------------------------------------
City | VAN NUYS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91405-2283
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-782-4300
-----------------------------------------------------
Fax | 818-782-6411
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 571286
-----------------------------------------------------
City | TARZANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91357-1286
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-782-4300
-----------------------------------------------------
Fax | 818-782-6411
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. DAVID LAVIAN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 818-782-4300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | A46370
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------