Organization
KGV EASY LEASING CORP
Active
Other names
PRIVILEGE DIAGNOSTIC
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY DAVIDOV (CEO)
(818) 980-1171
Entity
Organization
Contact information
Practice address
12501 CHANDLER BLVD, SUITE 102, VALLEY VILLAGE, CA 91607-1941
(818) 980-1171
(818) 763-8750
Mailing address
12501 CHANDLER BLVD, SUITE 102, VALLEY VILLAGE, CA 91607-1941
(818) 980-1171
(818) 763-8750
Taxonomy
Speciality
Code
Description
License number
State
2084D0003X
Diagnostic Neuroimaging (Psychiatry & Neurology) Physician
Primary
—
—
293D00000X
Physiological Laboratory
—
—
Other
Enumeration date
08/20/2008
Last updated
07/23/2009
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