Provider Demographics
NPI:1790208890
Name:CBKG MEDICAL CLINIC INC
Entity Type:Organization
Organization Name:CBKG MEDICAL CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YUZEF
Authorized Official - Middle Name:
Authorized Official - Last Name:GUROVICH
Authorized Official - Suffix:
Authorized Official - Credentials:M D,
Authorized Official - Phone:818-732-7300
Mailing Address - Street 1:12511 OXNARD ST
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-4458
Mailing Address - Country:US
Mailing Address - Phone:818-732-7300
Mailing Address - Fax:818-732-7302
Practice Address - Street 1:12511 OXNARD ST
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-4458
Practice Address - Country:US
Practice Address - Phone:818-732-7300
Practice Address - Fax:818-732-7302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty