Vital Medical Group, INC
Family Medicine in Glendale, CA. Organization (NPI-2).
NPI number1124886437
StatusActive
Last updated in NPPESApr 22, 2024
Details
- NPI
- 1124886437
- Entity type
- Organization (NPI-2)
- Legal business name
- Vital Medical Group, INC
- Organization subpart
- No
- Enumeration date
- Mar 11, 2024
- Certification date
- Apr 22, 2024
- Last updated
- Apr 22, 2024
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PART B SUPPLIER - CLINIC/GROUP PRACTICE
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | – | – | Yes |
Practice location
1314 W Glenoaks Blvd Ste 205Glendale, CA 91201-4890
Phone 818-396-5158 · Fax 818-396-5073
Mailing address
1314 W Glenoaks Blvd Ste 205Glendale, CA 91201-4890
Phone 818-396-5158 · Fax 818-396-5073
Authorized official
Maxwell Jen
Medical Director
8183965158
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