Provider Demographics
NPI:1285895987
Name:PERSONAL UNICARE MEDICAL CLINIC A MEDICAL CORPORATION
Entity type:Organization
Organization Name:PERSONAL UNICARE MEDICAL CLINIC A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DMITRY
Authorized Official - Middle Name:
Authorized Official - Last Name:OYKHERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-650-5530
Mailing Address - Street 1:1019 N FAIRFAX AVE
Mailing Address - Street 2:101
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046-6160
Mailing Address - Country:US
Mailing Address - Phone:323-650-5530
Mailing Address - Fax:323-650-5539
Practice Address - Street 1:1019 N FAIRFAX AVE
Practice Address - Street 2:101
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-6160
Practice Address - Country:US
Practice Address - Phone:323-650-5530
Practice Address - Fax:323-650-5539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-24
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37859208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty