Provider Demographics
NPI:1194999318
Name:VALLEY OAKS ORTHOPEDIC, INC.
Entity type:Organization
Organization Name:VALLEY OAKS ORTHOPEDIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KONSTANDIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KUMURYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-988-5414
Mailing Address - Street 1:4955 VAN NUYS BOULEVARD
Mailing Address - Street 2:SUITE 514
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403
Mailing Address - Country:US
Mailing Address - Phone:818-789-8593
Mailing Address - Fax:818-789-5863
Practice Address - Street 1:4955 VAN NUYS BOULEVARD
Practice Address - Street 2:SUITE 514
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403
Practice Address - Country:US
Practice Address - Phone:818-789-8593
Practice Address - Fax:818-789-5863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X
CA261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6096510001Medicare NSC