=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881655918
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHIFFMAN & BUCH MDS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/29/2006
-----------------------------------------------------
Last Update Date | 03/16/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15211 VANOWEN ST SUITE 207
-----------------------------------------------------
City | VAN NUYS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91405-3606
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-989-1917
-----------------------------------------------------
Fax | 818-989-0751
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15211 VANOWEN ST SUITE 207
-----------------------------------------------------
City | VAN NUYS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91405-3606
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-989-1917
-----------------------------------------------------
Fax | 818-989-0751
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | KENNETH L BUCH
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 818-989-1917
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | EN745A
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------