Victory Physical Rehabilitation, Inc

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

Legal business name

VICTORY PHYSICAL REHABILITATION, INC

Practice address

11631 Victory Blvd Ste 101B
North Hollywood, CA 91606-3572

Phone

(323) 645-1871

Fax

(818) 764-3032

NPI assigned

Jun 2, 2023

Last updated

Jun 2, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Michael Meyer Koshak, MDNPI 1689680696

Title

President

Phone

(818) 419-0049

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Michael M Koshak, MD

  • Family Medicine Physician
  • North Hollywood, CA
  • NPI 1689680696
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1685664000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1685664000000",
    "number": "1033803168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11631 VICTORY BLVD STE 101B",
            "city": "NORTH HOLLYWOOD",
            "state": "CA",
            "postal_code": "916063572",
            "telephone_number": "323-645-1871",
            "fax_number": "818-764-3032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11631 VICTORY BLVD STE 101B",
            "city": "NORTH HOLLYWOOD",
            "state": "CA",
            "postal_code": "916063572",
            "telephone_number": "323-645-1871",
            "fax_number": "818-764-3032"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICTORY PHYSICAL REHABILITATION, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-02",
        "last_updated": "2023-06-02",
        "certification_date": "2023-06-02",
        "status": "A",
        "authorized_official_last_name": "KOSHAK",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "MEYER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "818-419-0049",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Behrang Vameghi Vessali, PHYSICIAN ASSISTANT
• Victory Care Medical Supply Inc. (Victory Care Medical Supply)
• Victory Counseling and Psychosocial Education Inc (Chester Litvin, PhD)
• Victory Diagnostics Inc.
• Victory Hospice Care, Inc.
• Victory Plaza Dental Group Dental Office of Farnaz Kohan Inc.
• Victory Sleep Center Inc
• Vida for Autism, LLC
• Kierstyn Videgain
• Viewcrest Congregate Living

• Physical Medicine & Rehabilitation Physician in North Hollywood, CA
• Providers in North Hollywood, CA by specialty
• Physical Medicine & Rehabilitation Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.