Provider Demographics
NPI:1255588273
Name:KGV EASY LEASING CORP
Entity type:Organization
Organization Name:KGV EASY LEASING CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIDOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-980-1171
Mailing Address - Street 1:12501 CHANDLER BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-1941
Mailing Address - Country:US
Mailing Address - Phone:818-980-1171
Mailing Address - Fax:818-763-8750
Practice Address - Street 1:12501 CHANDLER BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-1941
Practice Address - Country:US
Practice Address - Phone:818-980-1171
Practice Address - Fax:818-763-8750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-20
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084D0003XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyDiagnostic NeuroimagingGroup - Single Specialty
No293D00000XLaboratoriesPhysiological LaboratoryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABX983AMedicare PIN
CATD052Medicare PIN