Provider Demographics
NPI:1417396318
Name:MY CHOICE MEDICAL CENTER, A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:MY CHOICE MEDICAL CENTER, A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAYMAN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:JOSPEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-487-6500
Mailing Address - Street 1:7232 VAN NUYS BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-2231
Mailing Address - Country:US
Mailing Address - Phone:866-397-3070
Mailing Address - Fax:
Practice Address - Street 1:7232 VAN NUYS BLVD STE 201
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-2231
Practice Address - Country:US
Practice Address - Phone:866-397-3070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-24
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA60633207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty