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NPI Code Detail

MEDICARE: TRIGEN MEDICAL GROUP

MEDICARE: TRIGEN MEDICAL GROUP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician
2207RP1001XPulmonary Disease Physician
3207RR0500XRheumatology Physician
42086X0206XSurgical Oncology Physician
5208800000XUrology Physician

General Provider Information

NPI Number : 1518618164
Entity Type Code : Organization
Provider Name (Legal Business Name) : TRIGEN MEDICAL GROUP
Provider Business Mailing Address
First Line : 12922 VICTORY BLVD
Second Line :
City : NORTH HOLLYWOOD
State : CA
Zip : 91606-2924
Country : US
Telephone Number : 818-760-2800
Fax Number : 818-760-7343
Provider Business Practice Location Address
First Line : 1972 E CESAR E CHAVEZ AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90033-1751
Country : US
Telephone Number : 818-760-2800
Fax Number :
Authorized Official
Title or Position : MANAGING PARTNER
Name : SOROUSH ADAM RAMIN
Credential : MD
Telephone Number : 818-760-2800
Provider Enumeration Date : 01/14/2022
Last Update Date : 01/14/2022

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Directions to “TRIGEN MEDICAL GROUP ” Practice Location

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