Innovative Medical Group Inc

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

A92365 Issued in CA

Legal business name

INNOVATIVE MEDICAL GROUP INC

Practice address

372 E Olive Ave
Burbank, CA 91502-1215

Phone

(818) 558-3777

Fax

(818) 558-3778

NPI assigned

Nov 19, 2012

Organization subpart

No

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

Authorized official

Name

Hrak Derderian, M.D.

Title

Ceo / Medical Director

Phone

(818) 558-3777

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1353283200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1374796800000",
    "number": "1821332503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "372 E OLIVE AVE",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "915021215",
            "telephone_number": "818-558-3777",
            "fax_number": "818-558-3778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "372 E OLIVE AVE",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "915021215",
            "telephone_number": "818-558-3777",
            "fax_number": "818-558-3778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-19",
        "last_updated": "2013-07-26",
        "status": "A",
        "authorized_official_last_name": "DERDERIAN",
        "authorized_official_first_name": "HRAK",
        "authorized_official_title_or_position": "CEO / MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "818-558-3777",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "A92365",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "A92365",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Infectious Disease Consultants Med GP
• Infinite Homehealth and Palliative Care Inc
• Infinite Vitality
• Infiniti Medical Services, PC
• Inga Simonian, PHD Psychology Group, Inc.
• Insight Imaging Center, Inc.
• Insite Digestive Health Care
• Integrated Allied Medical Group
• Integrative Mind and Medicine Inc.
• Integrity First Home Health Care Inc

• Emergency Medicine Physician in Burbank, CA
• Providers in Burbank, CA by specialty
• Emergency Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2013; 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.