Provider Demographics
NPI:1912033622
Name:JIMSHER MEDICAL GROUP,INC
Entity Type:Organization
Organization Name:JIMSHER MEDICAL GROUP,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:BORN
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:818-767-4728
Mailing Address - Street 1:2345 WARING DR
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-3018
Mailing Address - Country:US
Mailing Address - Phone:818-767-4728
Mailing Address - Fax:
Practice Address - Street 1:8001 LAUREL CANYON BLVD
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91605-1400
Practice Address - Country:US
Practice Address - Phone:818-767-4728
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGR0062150207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty