Provider Demographics
NPI:1235808478
Name:FAMILY CARE MD GROUP INC
Entity Type:Organization
Organization Name:FAMILY CARE MD GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:818-960-7171
Mailing Address - Street 1:8730 GLENOAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91352-2801
Mailing Address - Country:US
Mailing Address - Phone:818-960-7171
Mailing Address - Fax:818-960-7177
Practice Address - Street 1:8730 GLENOAKS BLVD
Practice Address - Street 2:
Practice Address - City:SUN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91352-2801
Practice Address - Country:US
Practice Address - Phone:818-960-7171
Practice Address - Fax:818-960-7177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty