Provider Demographics
NPI:1275992711
Name:LEADING MEDICAL GROUP INC.
Entity Type:Organization
Organization Name:LEADING MEDICAL GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MANI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOKOUFANDEH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:818-703-1511
Mailing Address - Street 1:22110 ROSCOE BLVD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91304-3845
Mailing Address - Country:US
Mailing Address - Phone:818-703-1511
Mailing Address - Fax:818-703-9911
Practice Address - Street 1:22110 ROSCOE BLVD
Practice Address - Street 2:SUITE 304
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91304-3845
Practice Address - Country:US
Practice Address - Phone:818-703-1511
Practice Address - Fax:818-703-9911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty