Provider Type Icon

BRENTWOOD MEDICAL GROUP A PROFESSIONAL MEDICAL CORP NPI 1720322415


NPI Information

NPI: 1720322415
Provider Name: BRENTWOOD MEDICAL GROUP A PROFESSIONAL MEDICAL CORP
Classification: Internal Medicine - 207R00000X
Entity Type: Organization

CLIA Number: 05D2163723

Address:
11645 WILSHIRE BLVD
SUITE 745
LOS ANGELES, CA
ZIP 90025
Phone: (310) 696-0101
Get Directions

BRENTWOOD MEDICAL GROUP A PROFESSIONAL MEDICAL CORP is an internal medicine in Los Angeles, CA. The provider is a physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. BRENTWOOD MEDICAL GROUP A PROFESSIONAL MEDICAL CORP NPI is 1720322415. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

11645 WILSHIRE BLVD
SUITE 745
LOS ANGELES, CA
ZIP 90025-708
Phone: (310) 696-0101

The provider's authorized official is Javid Tavari .
The authorized official title is President and has the following contact phone number (310) 696-0101.

The CLIA number assigned to this NPI record is 05D2163723 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/19/2012 and was last updated on 2/26/2018.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207R00000XInternal Medicine20A6273CALIFORNIAYes

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: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.