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Organization

KEVIN PEZESHKI MD INC

Active
Other names
SAN JOSEPH MEDICAL CLINIC
Organization subpart
No

Provider details

NPI number
Authorized official
DR. KEVIN PEZESHKI M.D. (MEDICAL DIRECTOR)
(818) 909-9955
Entity
Organization

Contact information

Practice address
13750 VICTORY BLVD, VAN NUYS, CA 91401-2324
(818) 909-9955
(818) 909-0454
Mailing address
13750 VICTORY BLVD, VAN NUYS, CA 91401-2324
(818) 909-9955
(818) 909-0454

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
A67148
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
GR0090250
CA
Enumeration date
08/20/2007
Last updated
08/20/2007
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