# MAX M GHANNADI MD MEDICAL CORP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003050873
- **Authorized official:** DR. MAX M GHANNADI M.D. (PRESIDENT)
- **Authorized official phone:** (818) 999-9096

## Contact information

- **Practice address:** 14103 VICTORY BLVD, SUITE 7, VAN NUYS, CA 91401
- **Practice address phone:** (818) 994-0000
- **Practice address fax:** (818) 988-2949
- **Mailing address:** 23679 CALABASAS RD, \# 327, CALABASAS, CA 91302-1502
- **Mailing address phone:** (818) 887-5515
- **Mailing address fax:** (818) 225-9230

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | A102618 | CA | Yes |

## Other

- **Enumeration date:** 04/24/2009
- **Last updated:** 10/04/2010