| 101 Family Medical Group,a Professional Corp | |
|
22030 Sherman Way Ste 101 Canoga Park CA 91303-1844 | |
| (818) 312-9101 | |
| (818) 312-9100 |
| Full Name | 101 Family Medical Group,a Professional Corp |
|---|---|
| Speciality | Clinic/Center |
| Location | 22030 Sherman Way Ste 101, Canoga Park, California |
| Authorized Official Name and Position | Hessam Aazami (MEDICAL DIRECTOR) |
| Authorized Official Contact | 8183129101 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| 101 Family Medical Group,a Professional Corp 7201 Rockridge Ter West Hills CA 91307-1265 Ph: (818) 312-9101 | 101 Family Medical Group,a Professional Corp 22030 Sherman Way Ste 101 Canoga Park CA 91303-1844 Ph: (818) 312-9101 |
| NPI Number | 1174856348 |
|---|---|
| Provider Enumeration Date | 09/06/2009 |
| Last Update Date | 04/07/2011 |
| Medicare PECOS PAC ID | 5890831580 |
|---|---|
| Medicare Enrollment ID | O20091010000007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174856348 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | A85704 (California) | Primary |
| Provider Name | Hessam Aazami |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1144299173 PECOS PAC ID: 1052307709 Enrollment ID: I20040420001733 |
| Provider Name | Jamsheed Akhavan |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1073661807 PECOS PAC ID: 4183813512 Enrollment ID: I20110114000845 |
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