Millenium Medical Group

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

License

A20315 Issued in CA

Legal business name

MILLENIUM MEDICAL GROUP

Practice address

211 S Maclay Ave
San Fernando, CA 91340-3603

Phone

(818) 365-6931

NPI assigned

Oct 8, 2009

Organization subpart

Yes

Parent organization

MILLENIUM MEDICAL GROUPAs reported in NPPES

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

Authorized official

Name

David Robert Johnson, MD

Title

Manager

Phone

(818) 365-6931

Specialties & licenses 1

Addresses

Other identifiers 1

Part of

Millenium Medical Group

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

{
    "created_epoch": "1254960000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1298937600000",
    "number": "1770818734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2980 N BEVERLY GLEN CIR STE 100",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900771728",
            "telephone_number": "310-474-9809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 S MACLAY AVE",
            "city": "SAN FERNANDO",
            "state": "CA",
            "postal_code": "913403603",
            "telephone_number": "818-365-6931"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MILLENIUM MEDICAL GROUP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MILLENIUM MEDICAL GROUP",
        "enumeration_date": "2009-10-08",
        "last_updated": "2011-03-01",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "818-365-6931",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": "CA",
            "license": "A20315",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BOARD",
            "identifier": "A20315",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jasleen Membreno, RBT
• Luis Mendes
• Kevin Rafael Mendoza
• Makayla Mendoza
• Tina Merati
• Nadine Centeno Miranda Luis
• Brenda L. Miranda
• Marissa Tecson Miranda
• Shahram S. Mirhashemi, M.D.
• Katayoun Mohajerani, DDS

• Orthopaedic Surgery Physician in San Fernando, CA
• Providers in San Fernando, CA by specialty
• Orthopaedic Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2011; 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.