Provider Demographics
NPI:1518191899
Name:NUTRITION MEDICAL CENTER INC
Entity Type:Organization
Organization Name:NUTRITION MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IAN
Authorized Official - Middle Name:
Authorized Official - Last Name:YIP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-615-2888
Mailing Address - Street 1:6325 TOPANGA CANYON BLVD
Mailing Address - Street 2:SUITE 315
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-2033
Mailing Address - Country:US
Mailing Address - Phone:818-615-2888
Mailing Address - Fax:818-615-2883
Practice Address - Street 1:6325 TOPANGA CANYON BLVD
Practice Address - Street 2:SUITE 315
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-2033
Practice Address - Country:US
Practice Address - Phone:818-615-2888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-14
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG73119207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEA128AMedicare PIN