| Advanced Hematology Oncology Medical Group Inc | |
|
6221 Wilshire Blvd Ste 504 Los Angeles CA 90048-5223 | |
| (323) 965-9995 | |
| (323) 965-5678 |
| Full Name | Advanced Hematology Oncology Medical Group Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 6221 Wilshire Blvd Ste 504, Los Angeles, California |
| Authorized Official Name and Position | Roman Kleynberg (PRESIDENT) |
| Authorized Official Contact | 3239659995 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Advanced Hematology Oncology Medical Group Inc 6221 Wilshire Blvd Ste 504 Los Angeles CA 90048-5223 Ph: (323) 965-9995 | Advanced Hematology Oncology Medical Group Inc 6221 Wilshire Blvd Ste 504 Los Angeles CA 90048-5223 Ph: (323) 965-9995 |
| NPI Number | 1083142376 |
|---|---|
| Provider Enumeration Date | 05/31/2017 |
| Last Update Date | 07/21/2022 |
| Medicare PECOS PAC ID | 3779840459 |
|---|---|
| Medicare Enrollment ID | O20171205002504 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083142376 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Ajmal Mohammad |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700017712 PECOS PAC ID: 2365570504 Enrollment ID: I20100510000669 |
| Provider Name | Roman L Kleynberg |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1700103298 PECOS PAC ID: 6406169713 Enrollment ID: I20150715002338 |
| Provider Name | Nidhi K Madana |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225479660 PECOS PAC ID: 4880983857 Enrollment ID: I20160513001204 |
| Provider Name | Rosan M Derayunan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740942481 PECOS PAC ID: 8628464195 Enrollment ID: I20220408002241 |
| Provider Name | Yaroslava Markov |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285418749 PECOS PAC ID: 1052723806 Enrollment ID: I20231003000001 |
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