Provider Demographics
NPI:1912381294
Name:KYRILLOS MEDICAL GROUP,INC
Entity Type:Organization
Organization Name:KYRILLOS MEDICAL GROUP,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:FAROUK
Authorized Official - Last Name:HABASHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-391-9193
Mailing Address - Street 1:1510 S CENTRAL AVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-2500
Mailing Address - Country:US
Mailing Address - Phone:818-502-0325
Mailing Address - Fax:818-242-5079
Practice Address - Street 1:1510 S CENTRAL AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-2500
Practice Address - Country:US
Practice Address - Phone:818-502-0325
Practice Address - Fax:818-242-5079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty