Provider Demographics
NPI:1952419632
Name:SYLMAR PHYSICIAN MEDICAL GROUP INC
Entity type:Organization
Organization Name:SYLMAR PHYSICIAN MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:HOUSHANG
Authorized Official - Middle Name:DANNY
Authorized Official - Last Name:PAVEHZADEH
Authorized Official - Suffix:SR
Authorized Official - Credentials:DC
Authorized Official - Phone:818-367-9068
Mailing Address - Street 1:12737 GLENOAKS BLVD
Mailing Address - Street 2:#12
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342
Mailing Address - Country:US
Mailing Address - Phone:818-367-9068
Mailing Address - Fax:818-367-9069
Practice Address - Street 1:12737 GLENOAKS BLVD
Practice Address - Street 2:#12
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342
Practice Address - Country:US
Practice Address - Phone:818-367-9068
Practice Address - Fax:818-367-9069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty