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General NPI Number Information
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NPI Number | 1790208890
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Entity Type | Organization
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Legal Business Name | CBKG MEDICAL CLINIC INC
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Dates
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Enumeration Date | 07/20/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 12511 OXNARD ST
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91606-4458
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Country | US
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Telephone | 818-732-7300
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Fax | 818-732-7302
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Provider Business Mailing Address
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Address Line | 12511 OXNARD ST
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91606-4458
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Country | US
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Telephone | 818-732-7300
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Fax | 818-732-7302
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Authorized Official
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Title or Position | PRESIDENT
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Name | YUZEF GUROVICH
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Credential | M. D,
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Telephone | 818-732-7300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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