Northwest Valley Family Medical Clinic, Inc.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

A70495 Issued in CA

Legal business name

NORTHWEST VALLEY FAMILY MEDICAL CLINIC, INC.

Practice address

21119 Devonshire St
Chatsworth, CA 91311

Phone

(818) 727-1974

Fax

(818) 727-7726

NPI assigned

Oct 4, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Martina Barte Masongsong, M.D.

Title

V.P./Treasurer

Phone

(818) 727-1974

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 1

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

• John Baykow Jung, M.D.

  • Family Medicine Physician
  • Saugus, CA
  • NPI 1699843359
  NPD (past)

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1932295474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19182 DUNURE PLACE",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "91326",
            "telephone_number": "818-368-2859",
            "fax_number": "818-727-7726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21119 DEVONSHIRE ST",
            "city": "CHATSWORTH",
            "state": "CA",
            "postal_code": "91311",
            "telephone_number": "818-727-1974",
            "fax_number": "818-727-7726"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST VALLEY FAMILY MEDICAL CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MASONGSONG",
        "authorized_official_first_name": "MARTINA",
        "authorized_official_middle_name": "BARTE",
        "authorized_official_title_or_position": "V.P./TREASURER",
        "authorized_official_telephone_number": "818-727-1974",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A70495",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0101261",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0101260",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Chatsworth, CA
• Providers in Chatsworth, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.