NPIMap

Organization Active NPI

Vanowen Radiological Medical Group, Inc.

  • Diagnostic Radiology Physician
  • Van Nuys, CA
National Provider Identifier
1699729848
Registry record updated Oct 11, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
VANOWEN RADIOLOGICAL MEDICAL GROUP, INC.
Practice address
15107 Vanowen St
Van Nuys, CA 91405-4542
Phone
(818) 902-2951
NPI assigned
May 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2007

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

Authorized official

Name
Larry Kussin, M.D.
Title
Medical Director
Phone
(818) 902-2951

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0202X Primary

Addresses

Primary practice location

15107 Vanowen St
Van Nuys, CA 91405-4542

Mailing address

PO Box 190
Simi Valley, CA 93062-0190
Phone (805) 522-5940

Other identifiers 3

IdentifierTypeStateIssuer
ZZZ73155ZOtherBLUE SHIELD
CU0807OtherRAILROAD MEDICARE
ZZZ73155ZMedicaidCA

National Provider Directory

National Provider Directory

Locations

44105 15th St W
Ste 100
Lancaster, CA 93534
Phone (661) 726-6050

12444 Victory Blvd
Ste 503
North Hollywood, CA 91606

15107 Vanowen St
Ste 106
Van Nuys, CA 91405

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1148083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192060800000",
    "number": "1699729848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 190",
            "city": "SIMI VALLEY",
            "state": "CA",
            "postal_code": "930620190",
            "telephone_number": "805-522-5940",
            "fax_number": "805-522-6401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15107 VANOWEN ST",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914054542",
            "telephone_number": "818-902-2951"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VANOWEN RADIOLOGICAL MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-20",
        "last_updated": "2007-10-11",
        "status": "A",
        "authorized_official_last_name": "KUSSIN",
        "authorized_official_first_name": "LARRY",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "818-902-2951",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ73155Z",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CU0807",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZZ73155Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Van Nuys, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.