Provider Demographics
NPI:1700408713
Name:MEDGEN INC
Entity Type:Organization
Organization Name:MEDGEN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:CHERIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-471-3287
Mailing Address - Street 1:19618 VENTURA BLVD
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-2919
Mailing Address - Country:US
Mailing Address - Phone:855-471-3287
Mailing Address - Fax:
Practice Address - Street 1:19618 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2919
Practice Address - Country:US
Practice Address - Phone:855-471-3287
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDGEN INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-05-13
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty