Provider Demographics
NPI:1386986826
Name:LIAKHOVETSKI,MD A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:LIAKHOVETSKI,MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OLEG
Authorized Official - Middle Name:
Authorized Official - Last Name:LIAKHOVETSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-599-5948
Mailing Address - Street 1:4940 VAN NUYS BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-1700
Mailing Address - Country:US
Mailing Address - Phone:818-528-1260
Mailing Address - Fax:818-528-1261
Practice Address - Street 1:4940 VAN NUYS BLVD
Practice Address - Street 2:STE 200
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-1700
Practice Address - Country:US
Practice Address - Phone:818-528-1260
Practice Address - Fax:818-528-1261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-22
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA103798207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty