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Organization
VANOWEN RADIOLOGICAL MEDICAL GROUP, INC.
Active
Organization
VANOWEN RADIOLOGICAL MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY KUSSIN M.D. (MEDICAL DIRECTOR)
(818) 902-2951
Entity
Organization
Contact information
Practice address
15107 VANOWEN ST, VAN NUYS, CA 91405-4542
(818) 902-2951
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
—
CU0807
RAILROAD MEDICARE
—
01
—
ZZZ73155Z
BLUE SHIELD
—
05
—
ZZZ73155Z
—
CA
Enumeration date
05/20/2006
Last updated
10/11/2007
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