Provider Demographics
NPI:1336656503
Name:SHERMAN OAKS MEDICAL ASSOCIATES A PROF CORP
Entity Type:Organization
Organization Name:SHERMAN OAKS MEDICAL ASSOCIATES A PROF CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:747-998-5300
Mailing Address - Street 1:15476 VENTURA BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-3002
Mailing Address - Country:US
Mailing Address - Phone:747-998-5300
Mailing Address - Fax:747-998-5277
Practice Address - Street 1:15476 VENTURA BLVD STE A
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-3002
Practice Address - Country:US
Practice Address - Phone:747-998-5300
Practice Address - Fax:747-998-5277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA31044207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty