MEDICARE: MAXHEALTH MEDICAL GROUP,INC.

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
1	207R00000X	Internal Medicine Physician	G45977	CA

General Provider Information

NPI Number	:	1558426460
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAXHEALTH MEDICAL GROUP,INC.

Provider Business Mailing Address
First Line	:	700 E COLORDAO ST
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91205-1710
Country	:	US
Telephone Number	:	818-241-1359
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 E COLORDAO ST
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91205-1710
Country	:	US
Telephone Number	:	818-241-1359
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. LEON G PHAM
Credential	:	PA
Telephone Number	:	818-421-7283

Provider Enumeration Date	:	12/22/2006
Last Update Date	:	08/22/2020

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