Provider Demographics
NPI:1962679431
Name:PROHEALTH-GLENDALE OCCUPATIONAL MEDICAL GRP.
Entity Type:Organization
Organization Name:PROHEALTH-GLENDALE OCCUPATIONAL MEDICAL GRP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SOHEIL
Authorized Official - Middle Name:S
Authorized Official - Last Name:YOUNAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-246-4800
Mailing Address - Street 1:222 W. EULALIA STREET
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204
Mailing Address - Country:US
Mailing Address - Phone:818-246-4800
Mailing Address - Fax:818-246-4805
Practice Address - Street 1:222 W. EULALIA STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204
Practice Address - Country:US
Practice Address - Phone:818-246-4800
Practice Address - Fax:818-246-4805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-13
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6596261QC1500X, 261QC1800X, 261QE0002X, 261QP2000X, 261QP2300X, 261QU0200X, 261QX0100X
CA261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health
No261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care