LAKESIDE MEDICAL ASSOCIATES A MEDICAL GROUP INC. NPI 1043256027

NPI Information

  • NPI: 1043256027
  • Provider Name: LAKESIDE MEDICAL ASSOCIATES, A MEDICAL GROUP, INC.
  • Classification: Family Medicine - 207Q00000X
  • Entity Type: Organization
  • Doing Business As: LAKESIDE COMMUNITY HEALTHCARE MEDICAL GROUP
  • CLIA Number: 05D1072811
  • Address: 607 S GLENOAKS BLVD
    BURBANK, CA
    ZIP 91502
  • Phone: (818) 557-2671

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NPI Details

LAKESIDE MEDICAL ASSOCIATES, A MEDICAL GROUP, INC. is a family medicine in Burbank, CA. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. LAKESIDE MEDICAL ASSOCIATES, A MEDICAL GROUP, INC. NPI is 1043256027. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Lakeside Community Healthcare Medical Group.

The provider's business location address is:

607 S GLENOAKS BLVD
BURBANK, CA
ZIP 91502-424
Phone: (818) 557-2671
Fax: (818) 557-0761

The provider's authorized official is Kerry E. Weiner .
The authorized official title is President and has the following contact phone number (818) 637-2000.

The CLIA number assigned to this NPI record is 05D1072811 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/20/2006 and was last updated on 5/12/2009.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363L00000XNurse PractitionerCALIFORNIANo
2207R00000XInternal MedicineNo
3207RR0500XInternal MedicineRheumatologyNo
4208000000XPediatricsNo
5207Q00000XFamily MedicineYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1W12279BMEDICARE PINCALIFORNIA
2W12279MEDICARE PIN
3GR0068382MEDICAIDCALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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