Provider Demographics
NPI:1104149269
Name:CURE4FEET PODIATRY GROUP INC
Entity type:Organization
Organization Name:CURE4FEET PODIATRY GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DPM
Authorized Official - Prefix:DR
Authorized Official - First Name:KHANH
Authorized Official - Middle Name:T
Authorized Official - Last Name:DUONG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:714-697-9939
Mailing Address - Street 1:5907 LANKERSHIM BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91601-1006
Mailing Address - Country:US
Mailing Address - Phone:818-980-3073
Mailing Address - Fax:866-818-0816
Practice Address - Street 1:5907 LANKERSHIM BLVD
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91601-1006
Practice Address - Country:US
Practice Address - Phone:818-980-3073
Practice Address - Fax:866-818-0816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-03
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4721213ES0103X
CAE4237213ES0103X
CAE5130213ES0103X
CA1927213ES0103X
CAE4839213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE1360Medicare PIN
CACK273AMedicare PIN
CAE4237JMedicare PIN
CAE4721Medicare PIN
CAE4159Medicare PIN
CAE5163Medicare UPIN
CAE5130Medicare UPIN
CA1927Medicare UPIN