Provider Demographics
NPI:1215993167
Name:VICTOR S HOGEN & ASSOCIATES MEDICAL GROUP INC
Entity type:Organization
Organization Name:VICTOR S HOGEN & ASSOCIATES MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:S
Authorized Official - Last Name:HOGEN
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:818-886-5591
Mailing Address - Street 1:18433 ROSCOE BLVD
Mailing Address - Street 2:STE 204
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325
Mailing Address - Country:US
Mailing Address - Phone:818-886-5591
Mailing Address - Fax:818-886-5593
Practice Address - Street 1:18433 ROSCOE BLVD
Practice Address - Street 2:STE 204
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325
Practice Address - Country:US
Practice Address - Phone:818-886-5591
Practice Address - Fax:818-886-5593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA13117208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A131170Medicaid
CA00A131170Medicaid
CAA13117Medicare ID - Type Unspecified