Organization
MILLENIUM MEDICAL GROUP
Active
Parent organization
MILLENIUM MEDICAL GROUP
Organization subpart
Yes
Provider details
NPI number
Legal business name
MILLENIUM MEDICAL GROUP
Authorized official
DAVID ROBERT JOHNSON MD (MANAGER)
(818) 365-6931
Entity
Organization
Contact information
Practice address
211 S MACLAY AVE, SAN FERNANDO, CA 91340-3603
(818) 365-6931
Mailing address
2980 N BEVERLY GLEN CIR STE 100, LOS ANGELES, CA 90077-1728
(310) 474-9809
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
A20315
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A20315
BOARD
CA
Enumeration date
10/08/2009
Last updated
03/01/2011
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