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General NPI Number Information
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NPI Number | 1487913810
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Entity Type | Organization
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Legal Business Name | CANOGA PARK URGENT CARE FAMILY MEDICINE
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Dates
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Enumeration Date | 05/04/2012
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Last Update Date | 10/22/2024
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Provider Practice Location Address
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Address Line | 20905 SHERMAN WAY
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City | CANOGA PARK
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State | CA
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Zip | 91303-1743
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Country | US
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Telephone | 818-744-4369
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Fax | 310-444-0606
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Provider Business Mailing Address
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Address Line | 20905 SHERMAN WAY
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City | CANOGA PARK
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State | CA
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Zip | 91303-1743
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Country | US
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Telephone | 818-744-4369
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Fax | 310-444-0606
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Authorized Official
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Title or Position | PRESIDENT
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Name | SYRUS FERIDOUNI
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Credential | M.D.
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Telephone | 818-744-4369
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | A92103
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | A97912
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License Number State | CA
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