Provider Demographics
NPI:1063462521
Name:PETER P. KOENIG, M.D., INCORPORATED
Entity Type:Organization
Organization Name:PETER P. KOENIG, M.D., INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:5 PERCET OR MORE OWNERSHIP INTEREST
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:P
Authorized Official - Last Name:KOENIG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-528-1222
Mailing Address - Street 1:4940 VAN NUYS BLVD.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-1741
Mailing Address - Country:US
Mailing Address - Phone:818-528-1222
Mailing Address - Fax:828-528-1225
Practice Address - Street 1:4940 VAN NUYS BLVD.
Practice Address - Street 2:SUITE 200
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-1741
Practice Address - Country:US
Practice Address - Phone:818-528-1222
Practice Address - Fax:828-528-1225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA23943207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1063462521OtherNPI
CA1063462521OtherNPI
CAW21606Medicare PIN