Provider Demographics
NPI:1558426460
Name:MAXHEALTH MEDICAL GROUP,INC.
Entity Type:Organization
Organization Name:MAXHEALTH MEDICAL GROUP,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LEON
Authorized Official - Middle Name:G
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:818-421-7283
Mailing Address - Street 1:700 E COLORDAO ST
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-1710
Mailing Address - Country:US
Mailing Address - Phone:818-241-1359
Mailing Address - Fax:
Practice Address - Street 1:700 E COLORDAO ST
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-1710
Practice Address - Country:US
Practice Address - Phone:818-241-1359
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG45977207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty