Provider Demographics
NPI:1124350129
Name:NOHO MEDICAL GROUP INC
Entity type:Organization
Organization Name:NOHO MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:PFUPAJENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-509-0545
Mailing Address - Street 1:11490 BURBANK BLVD STE 1C
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91601-2391
Mailing Address - Country:US
Mailing Address - Phone:818-509-0545
Mailing Address - Fax:818-863-1812
Practice Address - Street 1:11490 BURBANK BLVD STE 1C
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91601-2391
Practice Address - Country:US
Practice Address - Phone:818-509-0545
Practice Address - Fax:818-863-1812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG29345174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty