| Private Medical Group | |
|
22600 Ventura Blvd. Suite 104 Woodland Hills CA 91364-1458 | |
| (818) 225-1617 | |
| (818) 225-1620 |
| Full Name | Private Medical Group |
|---|---|
| Speciality | Internal Medicine |
| Location | 22600 Ventura Blvd., Woodland Hills, California |
| Authorized Official Name and Position | Robert Kevin Hanson (OWNER) |
| Authorized Official Contact | 8182251617 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Private Medical Group 22600 Ventura Blvd. Suite 104 Woodland Hills CA 91364-1458 Ph: (818) 225-1617 | Private Medical Group 22600 Ventura Blvd. Suite 104 Woodland Hills CA 91364-1458 Ph: (818) 225-1617 |
| NPI Number | 1710104369 |
|---|---|
| Provider Enumeration Date | 04/18/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710104369 | NPI | - | NPPES |
| G62711 | Other | CA | STATE LICENSE |
| ZZZ90227Z | Other | OLD GROUP IDENTIFIER # |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | G62711 (California) | Primary |
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