Provider Demographics
NPI:1285817197
Name:CITY DIAGNOSTIC MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:CITY DIAGNOSTIC MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KAYE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-871-3434
Mailing Address - Street 1:22631 PACIFIC COAST HWY
Mailing Address - Street 2:#441
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-5036
Mailing Address - Country:US
Mailing Address - Phone:310-871-3434
Mailing Address - Fax:206-202-4724
Practice Address - Street 1:20301 VENTURA BLVD
Practice Address - Street 2:115
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-2447
Practice Address - Country:US
Practice Address - Phone:818-992-1801
Practice Address - Fax:206-202-4724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG029768207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & NeurotologyGroup - Multi-Specialty