Provider Demographics
NPI:1952557050
Name:SUMMIT FAMILY HEALTH CENTER OF SHERMAN OAKS
Entity Type:Organization
Organization Name:SUMMIT FAMILY HEALTH CENTER OF SHERMAN OAKS
Other - Org Name:SUMMIT HEALTH CENTER OF SHERMAN OAKS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SIANG
Authorized Official - Middle Name:LIAN
Authorized Official - Last Name:LO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:818-468-2098
Mailing Address - Street 1:4849 VAN NUYS BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-2110
Mailing Address - Country:US
Mailing Address - Phone:818-788-5788
Mailing Address - Fax:818-981-9884
Practice Address - Street 1:4849 VAN NUYS BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-2110
Practice Address - Country:US
Practice Address - Phone:818-788-5788
Practice Address - Fax:818-981-9884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-08
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFNP 1841261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care