LAKESIDE MEDICAL ASSOCIATES A MEDICAL GROUP INC. NPI 1689874596

NPI Information

  • NPI: 1689874596
  • 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: 05D1032697
  • Address: 191 S BUENA VISTA ST
    SUITE 150
    BURBANK, CA
    ZIP 91505
  • Phone: (818) 295-5920

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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 1689874596. 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:

191 S BUENA VISTA ST
SUITE 150
BURBANK, CA
ZIP 91505-554
Phone: (818) 295-5920
Fax: (818) 295-6965

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 05D1032697 - other - urgent care facility with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 7/19/2007 and was last updated on 10/27/2009.

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
1207P00000XEmergency MedicineNo
2207R00000XInternal MedicineNo
3363L00000XNurse PractitionerNo
4363A00000XPhysician AssistantNo
5208000000XPediatricsNo
6207Q00000XFamily 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
1GR006838AMEDICAIDCALIFORNIA
2W12279BMEDICARE PINCALIFORNIA
3W12279MEDICARE PINCALIFORNIA

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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