Organization Name: | PERSONAL UNICARE MEDICAL CLINIC A MEDICAL CORPORATION |
NPI Number: | 1285895987 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DMITRY OYKHERMAN (OFFICE MANAGER) |
Mailing Address: | 1019 N Fairfax Ave 101 West Hollywood |
State: | CA US |
Postal Code: | 900466160 |
Phone Number: | 3236505530 |
Fax Number: | 3236505539 |
NPI Enumeration Date: | 06/24/2008 |
NPI Last Update Date: | 05/08/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | A37859 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |