Provider Demographics
NPI:1003050873
Name:MAX M GHANNADI MD MEDICAL CORP
Entity Type:Organization
Organization Name:MAX M GHANNADI MD MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAX
Authorized Official - Middle Name:M
Authorized Official - Last Name:GHANNADI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-999-9096
Mailing Address - Street 1:23679 CALABASAS RD
Mailing Address - Street 2:# 327
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-1502
Mailing Address - Country:US
Mailing Address - Phone:818-887-5515
Mailing Address - Fax:818-225-9230
Practice Address - Street 1:14103 VICTORY BLVD
Practice Address - Street 2:SUITE 7
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401
Practice Address - Country:US
Practice Address - Phone:818-994-0000
Practice Address - Fax:818-988-2949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-24
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA102618208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty