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General NPI Number Information
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NPI Number | 1952155855
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Entity Type | Organization
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Legal Business Name | FORWARD UROLOGY MEDICAL GROUP APC
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Dates
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Enumeration Date | 04/16/2024
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Last Update Date | 05/06/2024
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Provider Practice Location Address
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Address Line | 1720 E CESAR E CHAVEZ AVE
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City | LOS ANGELES
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State | CA
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Zip | 90033-2414
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Country | US
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Telephone | 310-779-2289
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Fax |
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Provider Business Mailing Address
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Address Line | 12652 W SUNSET BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90049-3831
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Country | US
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Telephone | 310-779-2289
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | NAT CHANDRA
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Credential |
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Telephone | 818-605-2393
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086X0206X
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Taxonomy Name | Surgical Oncology 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 | 2088F0040X
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Taxonomy Name | Urogynecology and Reconstructive Pelvic Surgery (Urology) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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