Provider Demographics
NPI:1205217643
Name:COLUMBIA CENTER FOR INTEGRATIVE MEDICINE
Entity type:Organization
Organization Name:COLUMBIA CENTER FOR INTEGRATIVE MEDICINE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:C E O
Authorized Official - Prefix:DR
Authorized Official - First Name:DUSHYANT
Authorized Official - Middle Name:
Authorized Official - Last Name:VISWANATHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-250-2246
Mailing Address - Street 1:21900 BURBANK BLVD
Mailing Address - Street 2:300
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-6469
Mailing Address - Country:US
Mailing Address - Phone:888-250-2246
Mailing Address - Fax:844-233-7639
Practice Address - Street 1:21900 BURBANK BLVD
Practice Address - Street 2:300
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-6469
Practice Address - Country:US
Practice Address - Phone:888-250-2246
Practice Address - Fax:844-233-7639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-11
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA140801208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1205217643OtherCA-NPI
MD1205217643OtherMD-NPI