# MILLENIUM MEDICAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MILLENIUM MEDICAL GROUP
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1770818734
- **Legal business name:** MILLENIUM MEDICAL GROUP
- **Authorized official:** DAVID ROBERT JOHNSON MD (MANAGER)
- **Authorized official phone:** (818) 365-6931

## Contact information

- **Practice address:** 211 S MACLAY AVE, SAN FERNANDO, CA 91340-3603
- **Practice address phone:** (818) 365-6931
- **Mailing address:** 2980 N BEVERLY GLEN CIR STE 100, LOS ANGELES, CA 90077-1728
- **Mailing address phone:** (310) 474-9809

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | A20315 | CA | Yes |

## Other

- **Enumeration date:** 10/08/2009
- **Last updated:** 03/01/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | A20315 | BOARD | CA |