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General NPI Number Information
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NPI Number | 1669966651
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Entity Type | Organization
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Legal Business Name | KBG MED CLINIC AND URGENT CARE, INC.
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Dates
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Enumeration Date | 06/21/2018
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Last Update Date | 06/21/2018
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Provider Practice Location Address
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Address Line | 5353 BALBOA BLVD STE 201
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City | ENCINO
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State | CA
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Zip | 91316-2865
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Country | US
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Telephone | 818-788-7840
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Fax | 818-788-7842
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Provider Business Mailing Address
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Address Line | 5353 BALBOA BLVD STE 201
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City | ENCINO
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State | CA
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Zip | 91316-2865
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Country | US
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Telephone | 818-788-7840
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Fax | 818-788-7842
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. KAYSAN GHASSEMINEJAD
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Credential | NA
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Telephone | 310-892-5501
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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