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General NPI Number Information
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NPI Number | 1689636730
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Entity Type | Organization
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Legal Business Name | BURBANK EMERGENCY MEDICAL GROUP INC
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Dates
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Enumeration Date | 04/04/2006
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Last Update Date | 07/09/2024
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Provider Practice Location Address
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Address Line | 501 S BUENA VISTA ST EM DEPT
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City | BURBANK
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State | CA
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Zip | 91505-4809
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Country | US
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Telephone | 818-843-5111
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Fax |
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Provider Business Mailing Address
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Address Line | 501 S BUENA VISTA ST
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City | BURBANK
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State | CA
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Zip | 91505-4809
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Country | US
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Telephone | 818-847-4055
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Fax | 818-848-4320
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Authorized Official
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Title or Position | PRESIDENT
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Name | STEPHEN EDWARD KISHINEFF
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Credential | MD
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Telephone | 818-847-4055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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