Provider Demographics
NPI:1942607932
Name:MONZER KADDOUR MD INC
Entity Type:Organization
Organization Name:MONZER KADDOUR MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MONZER
Authorized Official - Middle Name:
Authorized Official - Last Name:KADDOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-451-4308
Mailing Address - Street 1:19528 VENTURA BLVD
Mailing Address - Street 2:468
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-2917
Mailing Address - Country:US
Mailing Address - Phone:661-287-3162
Mailing Address - Fax:661-287-3951
Practice Address - Street 1:19528 VENTURA BLVD
Practice Address - Street 2:468
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2917
Practice Address - Country:US
Practice Address - Phone:661-287-3162
Practice Address - Fax:661-287-3951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-19
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC53238207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty