Organization
EXECUTIVE MEDICAL GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEAN-CLAUDE KIARASH (CEO)
(310) 381-9093
Entity
Organization
Contact information
Practice address
1115 AQUA VISTA ST, UNIT 405, NORTH HOLLYWOOD, CA 91602
(310) 381-9093
Mailing address
8605 SANTA MONICA BLVD, WEST HOLLYWOOD, CA 90069-4109
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251E00000X
Home Health Agency
Primary
—
—
251G00000X
Community Based Hospice Care Agency
—
—
251J00000X
Nursing Care Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
Other
Enumeration date
12/15/2022
Last updated
12/15/2022
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