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Organization
VANOWEN RADIOLOGY MEDICAL GROUP
Active
Organization
VANOWEN RADIOLOGY MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY KUSSIN M.D. (MEDICAL DIRECTOR)
(818) 782-6110
Entity
Organization
Contact information
Practice address
15243 VANOWEN ST STE 106, VAN NUYS, CA 91405-3632
(818) 782-6110
Mailing address
PO BOX 190, SIMI VALLEY, CA 93062-0190
(805) 522-5940
(805) 522-6401
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CS9153
RAILROAD MEDICARE
—
05
—
GR0082840
—
CA
01
—
ZZZ73154Z
BLUE SHIELD
—
05
—
ZZZ73154Z
—
CA
Enumeration date
05/20/2006
Last updated
06/16/2009
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