Provider Demographics
NPI:1568722957
Name:STEVEN G KHWARG MD PROF CORP
Entity Type:Organization
Organization Name:STEVEN G KHWARG MD PROF CORP
Other - Org Name:L.A. EYE MEDICAL GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT OF PROFESSIONAL CORPORATI
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:G
Authorized Official - Last Name:KHWARG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-484-1000
Mailing Address - Street 1:3055 WILSHIRE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-1119
Mailing Address - Country:US
Mailing Address - Phone:213-484-1000
Mailing Address - Fax:213-484-2662
Practice Address - Street 1:3055 WILSHIRE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-1119
Practice Address - Country:US
Practice Address - Phone:213-484-1000
Practice Address - Fax:213-484-2662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-21
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG47726B207W00000X
G477262207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty