| Vital Medical Group, Inc | |
|
1314 W Glenoaks Blvd Ste 205 Glendale CA 91201-4890 | |
| (818) 396-5158 | |
| (818) 396-5073 |
| Full Name | Vital Medical Group, Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 1314 W Glenoaks Blvd Ste 205, Glendale, California |
| Authorized Official Name and Position | Maxwell Jen (MEDICAL DIRECTOR) |
| Authorized Official Contact | 8183965158 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vital Medical Group, Inc 1314 W Glenoaks Blvd Ste 205 Glendale CA 91201-4890 Ph: (818) 396-5158 | Vital Medical Group, Inc 1314 W Glenoaks Blvd Ste 205 Glendale CA 91201-4890 Ph: (818) 396-5158 |
| NPI Number | 1124886437 |
|---|---|
| Provider Enumeration Date | 03/11/2024 |
| Last Update Date | 04/22/2024 |
| Medicare PECOS PAC ID | 5597106930 |
|---|---|
| Medicare Enrollment ID | O20240515004361 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124886437 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Maxwell Y Jen |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1154688810 PECOS PAC ID: 3779895891 Enrollment ID: I20150702000667 |
| Provider Name | Amir H Rahnavard |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1669755153 PECOS PAC ID: 8123376407 Enrollment ID: I20180802001247 |
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