=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801274774
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SILVER LAKE MEDICAL CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/12/2015
-----------------------------------------------------
Last Update Date | 05/12/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1711 W TEMPLE ST SUITE 5662
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90026-5421
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-413-8660
-----------------------------------------------------
Fax | 213-353-9075
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1711 W TEMPLE ST SUITE 5662
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90026-5421
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-413-8660
-----------------------------------------------------
Fax | 213-353-9075
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | GENERAL PRACTITIONER
-----------------------------------------------------
Name | MR. ARET AKIAN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 213-413-8660
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | 95002121
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------