MEDICARE: DR. VINOD M ASSOMULL SR. MD

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	207RN0300X	Nephrology Physician	A31336	CA

General Provider Information

NPI Number	:	1982619359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VINOD M ASSOMULL SR. MD

Provider Business Mailing Address
First Line	:	16809 OAK VIEW DR
Second Line	:
City	:	ENCINO
State	:	CA
Zip	:	91436-3239
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10605 BALBOA BLVD
Second Line	:	240
City	:	GRANADA HILLS
State	:	CA
Zip	:	91344-6342
Country	:	US
Telephone Number	:	661-254-0193
Fax Number	:	661-254-2248

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	01/28/2014

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