Provider Demographics
NPI:1891358610
Name:AMERICAN MEDICAL O&P CLINIC, INC.
Entity Type:Organization
Organization Name:AMERICAN MEDICAL O&P CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KONSTANDIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KUMURYAN
Authorized Official - Suffix:
Authorized Official - Credentials:CPED
Authorized Official - Phone:818-988-5414
Mailing Address - Street 1:4955 VAN NUYS BLVD STE 514
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-1831
Mailing Address - Country:US
Mailing Address - Phone:818-988-5414
Mailing Address - Fax:818-988-5415
Practice Address - Street 1:4955 VAN NUYS BLVD STE 514
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-1831
Practice Address - Country:US
Practice Address - Phone:818-988-5414
Practice Address - Fax:818-988-5415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-17
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier