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General NPI Number Information
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NPI Number | 1508953563
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Entity Type | Organization
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Legal Business Name | YORK MEDICAL GROUP
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Dates
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Enumeration Date | 10/09/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6027 YORK BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90042-3503
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Country | US
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Telephone | 323-256-1556
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Fax | 323-256-1836
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Provider Business Mailing Address
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Address Line | 6027 YORK BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90042-3503
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Country | US
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Telephone | 323-256-1556
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Fax | 323-256-1836
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Authorized Official
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Title or Position | OWNER/MD
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Name | RAISA HEIFETS
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Credential | MD
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Telephone | 323-256-1556
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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 | A40429
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License Number State | CA
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