LAKESIDE MEDICAL ASSOCIATES A MEDICAL GROUP, INC. (NPI# 1205002862) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205002862 |
| Entity Type | Organization |
| Organization Name | LAKESIDE MEDICAL ASSOCIATES A MEDICAL GROUP, INC. |
| Other Organization Name | LAKESIDE COMMUNITY HEALTHCARE MEDICAL GROUP |
| Practice Address |
1510 S Central Ave Suite 300 Glendale CA 91204-2500 |
| Mailing Address |
777 Flower Street Suite A Glendale CA 91201-3000 |
| Practice Telephone | 8182541511 |
| Practice Fax Number | 8182541500 |
| Mailing Telephone | 8186372000 |
| Mailing Fax Number | 8182428761 |
| Enumeration Date | 2008-05-05 |
| Last Update Date | 2009-05-11 |
| Authorized Official Name | DR. KERRY WEINER (PRESIDENT) |
| Authorized Official Telephone | 8186372000 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians | ||
| N | 207RG0100X |
Internal Medicine Specialization: Gastroenterology |
Allopathic & Osteopathic Physicians | ||
| N | 208D00000X | General Practice | Allopathic & Osteopathic Physicians | ||
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | 1205002862 | 05 |
| Other Name | Type Code |
|---|---|
| Lakeside Community Healthcare Medical Group | Doing Business As Name - Organization |
| Street Address |
1510 S CENTRAL AVE SUITE 300 |
| City | GLENDALE |
| State | CA |
| Zip Code | 91204-2500 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124020136 | Richard W Suda | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 1510 S Central Ave, Suite 530, Glendale, CA 91204-2500 | 2005-08-10 |
| 1912381294 | Kyrillos Medical Group,inc | Specialist | 1510 S Central Ave, Suite 250, Glendale, CA 91204-2500 | 2015-07-16 |
| 1942699236 | Major Medical Management, Inc. | Clinic/Center | 1510 S Central Ave, Ste 120, Glendale, CA 91204-2500 | 2015-01-09 |
| 1124449384 | Mardi H. Mihranian | Specialist | 1510 S Central Ave, Suite 100, Glendale, CA 91204-2500 | 2013-12-13 |
| 1922429182 | Susan L. Chobanian, M.d. | Specialist | 1510 S Central Ave, Suite 100, Glendale, CA 91204-2500 | 2013-12-13 |
| 1861834178 | Ivan Brando Teves Aguilera | Podiatrist | 1510 S Central Ave, Ste 120, Glendale, CA 91204-2576 | 2013-07-28 |
| 1205176690 | Global Research Management, Inc | Specialist | 1510 S Central Ave, Suite 300, Glendale, CA 91204-2500 | 2013-02-21 |
| 1013206945 | Yen Tun Wang | Dermatology | 1510 S Central Ave, Suite 470, Glendale, CA 91204-2500 | 2011-03-31 |
| 1902105059 | Amandeep Kaur Randhawa | Podiatrist | 1510 S Central Ave, Suite 120, Glendale, CA 91204-2500 | 2011-03-15 |
| 1952543886 | Nathan Malcolm Miller | Chiropractor | 1510 S Central Ave, Suite 120, Glendale, CA 91204-2500 | 2009-03-24 |
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|---|---|---|---|---|
| 1558997387 | Hope & Trust Trading LLC | Radiology | 318 W Colorado St #2, Glendale, CA 91204 | 2020-03-12 |
| 1972133387 | Yusuf Toliver | Counselor | 1027 S Central Ave, Suite 200, Glendale, CA 91204 | 2020-01-24 |
| 1538633136 | Pathology La Inc. | Clinical Medical Laboratory | 4634 San Fernando Rd., Same As Above, Glendale, CA 91204 | 2019-01-16 |
| 1295254050 | Glendale Back and Pain Center | Neurological Surgery | 710 S. Central Ave, Suite 240, Glendale, CA 91204 | 2017-09-13 |
| 1285163568 | Ez Trans, Inc. | Transportation Broker | 1626 S. Central Ave., Glendale, CA 91204 | 2017-06-08 |
| 1194254474 | Jenny Chung | Pharmacist | 3943 San Fernando Road, Glendale, CA 91204 | 2017-06-08 |
| 1396111886 | Fresenius Medical Care Glendale, LLC | Clinic/Center | 623 S Central Ave, Glendale, CA 91204 | 2015-08-19 |
| 1710302450 | New Age Foot and Ankle Podiatry PC | Podiatrist | 705 Ivy Street, Glendale, CA 91204 | 2014-03-04 |
| 1124454376 | Alber K. Karamanoukian Medical Clinic, Inc. | Clinic/Center | 810 S. Central Avenue, Suite 100, Glendale, CA 91204 | 2013-09-19 |
| 1548521156 | Glendale Plastic and Reconstructive Surgery Inc. | Plastic Surgery | 1500 S. Central Ave. #126, Glendale, CA 91204 | 2012-05-31 |
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| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
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| 1356967327 | Kristian Adair | Family Medicine | 7200 W Bell Rd Ste E102, Glendale, AZ 85308-8534 | 2020-06-24 |
| 1336761295 | Glendale Whole Health | Family Medicine | 230 N Maryland Aave #110, Glendale, CA 91206 | 2020-05-14 |
| 1053930248 | Shine Mmg Inc | Family Medicine | 450 N Brand Blvd Ste 625a, Glendale, CA 91203-2347 | 2020-04-08 |
| 1497381446 | Leonardo C Ortiz Md A Medical Corporation | Family Medicine | 2145 Ashington Dr, Glendale, CA 91206-1140 | 2020-03-20 |
| 1508498130 | Nare Stepanyan Md Inc | Family Medicine | 1030 S Glendale Ave Ste 503, Glendale, CA 91205-2820 | 2020-02-11 |
| 1194368530 | Carolyn Kathan | Family Medicine | 3732 W Charleston Ave, Glendale, AZ 85308-2708 | 2019-10-17 |
| 1932740966 | Starcare Homes LLC | Family Medicine | 9416 W Colter St, Glendale, AZ 85305-3373 | 2019-10-01 |
| 1871050559 | Mensa Family Clinic Inc | Family Medicine | 1110 S Glendale Ave Ste E, Glendale, CA 91205-5623 | 2019-02-28 |
| 1891279907 | Denise M Gomez | Family Medicine | 7200 W Bell Rd Unit 101, Glendale, AZ 85308-8529 | 2018-09-24 |
| 1427537299 | Brilliant Health Center Inc | Family Medicine | 1014 E Colorado St, Glendale, CA 91205-1226 | 2018-08-12 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.