Provider Demographics
NPI:1285931105
Name:DAVID LAVIAN M.D. INC.
Entity type:Organization
Organization Name:DAVID LAVIAN M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LAVIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-782-4300
Mailing Address - Street 1:PO BOX 571286
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91357-1286
Mailing Address - Country:US
Mailing Address - Phone:818-782-4300
Mailing Address - Fax:818-782-6411
Practice Address - Street 1:14600 SHERMAN WAY
Practice Address - Street 2:SUITE 215
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-2283
Practice Address - Country:US
Practice Address - Phone:818-782-4300
Practice Address - Fax:818-782-6411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-13
Last Update Date:2011-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA46370207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A463700Medicaid
CAA63439Medicare UPIN