LAKESIDE MEDICAL ASSOCIATES, A MEDICAL GROUP, INC. (NPI# 1689869760) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689869760 |
| Entity Type | Organization |
| Organization Name | LAKESIDE MEDICAL ASSOCIATES, A MEDICAL GROUP, INC. |
| Other Organization Name | LAKESIDE COMMUNITY HEALTHCARE MEDICAL GROUP |
| Practice Address |
12660 Riverside Dr Suite 225 N Hollywood CA 91607-3429 |
| Mailing Address |
777 Flower St Ste A Glendale CA 91201-3000 |
| Practice Telephone | 8187550265 |
| Practice Fax Number | 8187539074 |
| Mailing Telephone | 8186372000 |
| Mailing Fax Number | 8182428761 |
| Enumeration Date | 2007-09-11 |
| Last Update Date | 2009-05-06 |
| Authorized Official Name | KERRY E. WEINER (PRESIDENT) |
| Authorized Official Telephone | 8186372000 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians | ||
| Y | 207N00000X | Dermatology | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | GR0068384 | 05 |
| Other Name | Type Code |
|---|---|
| Lakeside Community Healthcare Medical Group | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104072339 | Lakeside Medical Associates, A Medical Group, Inc. | Obstetrics & Gynecology | 7345 Medical Center Drive, Suite 500, West Hills, CA 91307-1964 | 2008-08-07 |
| 1962667857 | Lakeside Medical Associates, A Medical Group, Inc. | Obstetrics & Gynecology | 191 S Buena Vista St, Suite 440, Burbank, CA 91505-4504 | 2008-07-21 |
| 1801051784 | Lakeside Medical Associates, A Medical Group, Inc. | Internal Medicine | 1500 W West Covina Pkwy, West Covina, CA 91790-2708 | 2008-07-21 |
| 1083879969 | Lakeside Medical Associates, A Medical Group, Inc. | Internal Medicine | 3605 Alamo St, Suite 100, Simi Valley, CA 93063-2186 | 2008-07-21 |
| 1538323993 | Lakeside Medical Associates, A Medical Group, Inc. | Internal Medicine | 612 E Janss Rd, Thousand Oaks, CA 91360-5113 | 2008-07-15 |
| 1104001288 | Lakeside Medical Associates, A Medical Group, Inc. | Internal Medicine | 1500 S Central Ave, Suite 320, Glendale, CA 91204-2530 | 2008-01-08 |
| 1689874596 | Lakeside Medical Associates, A Medical Group, Inc. | Emergency Medicine | 191 S Buena Vista St, Suite 150, Burbank, CA 91505-4554 | 2007-07-19 |
| 1639374069 | Lakeside Medical Associates, A Medical Group, Inc. | Internal Medicine | 4835 Van Nuys Blvd, Suite 114, Sherman Oaks, CA 91403-2109 | 2007-06-16 |
| 1659576072 | Lakeside Medical Associates, A Medical Group, Inc. | Internal Medicine | 1500 S Central Ave, Suite 326, Glendale, CA 91204-2530 | 2007-06-16 |
| 1487859815 | Lakeside Medical Associates, A Medical Group, Inc. | Urology | 25775 Mcbean Pkwy, Suite 107, Valencia, CA 91355-3708 | 2007-06-16 |
| Street Address |
12660 RIVERSIDE DR SUITE 225 |
| City | N HOLLYWOOD |
| State | CA |
| Zip Code | 91607-3429 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235131343 | Eric J Pinderski | Internal Medicine | 12660 Riverside Dr, Ste 310, N Hollywood, CA 91607-3431 | 2005-06-01 |
| 1609871920 | Elena F Kandel | Dermatology | 12660 Riverside Dr, Ste 225, N Hollywood, CA 91607-3469 | 2005-06-14 |
| 1083616031 | Karen I Virley | Internal Medicine | 12660 Riverside Dr, Ste 310, N Hollywood, CA 91607-3431 | 2005-06-02 |
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|---|---|---|---|---|
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| 1952926552 | Lisa Porter, Family Counselor, Inc | Marriage & Family Therapist | 4721 Laurel Canyon Blvd. Ste #200, Studio City, CA 91607 | 2020-06-10 |
| 1508488362 | Agm Rx Inc | Pharmacy | 12043 Riverdside Dr, Valley Village, CA 91607 | 2020-05-14 |
| 1275179327 | Go To Pharmacy Inc | Pharmacy | 5961 Laurel Canyon Ave #2, North Hollywood, CA 91607 | 2019-11-25 |
| 1689224545 | Canyon Rx Inc | Pharmacy | 12117 Magnolia Blvd, Valley Village, CA 91607 | 2019-09-12 |
| 1306311006 | Jeanine Ann Roose | Psychologist | 4941 Wilkinson Ave. Ste. A, Valley Village, CA 91607 | 2018-10-09 |
| 1790250942 | Janine Castagnetti | Speech-Language Pathologist | 5825 Radford Ave, Valley Village, CA 91607 | 2018-10-03 |
| 1871007724 | Valley Village Home Care Inc | Home Health | 5940 1/2 Laurel Canyon Blvd, Valley Village, CA 91607 | 2017-11-29 |
| 1740705185 | Archwood Care 2 | Intermediate Care Facility, Mentally Retarded | 12523 Califa St, Valley Village, CA 91607 | 2017-08-07 |
| 1932653664 | American Institute of Addiction Medicine | Substance Abuse Rehabilitation Facility | 12400 W Magnolia Blvd, Valley Village, CA 91607 | 2016-08-10 |
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| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609871920 | Elena F Kandel | Dermatology | 12660 Riverside Dr, Ste 225, N Hollywood, CA 91607-3469 | 2005-06-14 |
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|---|---|---|---|---|
| 1275144024 | Lumins Aesthetic and Wellness, Inc | Dermatology | 20281 Sw Birch St, Suite 201, Newport Beach, CA 92660 | 2020-08-14 |
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| 1033730981 | Adrianna Janell Browne, Md, Inc. | Dermatology | 8 Camino Encinas Ste 115, Orinda, CA 94563-3350 | 2020-05-01 |
| 1215564877 | Jasmine Khachatrian | Dermatology | 302 Sierra Woods Dr, Sierra Madre, CA 91024-1015 | 2020-03-24 |
| 1386277499 | Jessica Hsu, M.d.,inc | Dermatology | 1506 Chapman Avenue, Address Line 2, Orange, CA 92866 | 2020-02-17 |
| 1245862101 | Yuval Bibi, A Professional Corporation | Dermatology | 7266 Franklin Ave Apt 321, Los Angeles, CA 90046-8324 | 2020-02-09 |
| 1457982001 | Modesty Joy Isaguirre | Dermatology | 140 S Grand Ave, Glendora, CA 91741-4259 | 2020-02-03 |
| 1790322063 | Mfc Dermatology | Dermatology | 3655 Lomita Blvd Ste 221, Torrance, CA 90505-1918 | 2019-12-05 |
| 1336784206 | Barbara Kinkle Pa Inc., A Physician Assistant Corporation | Dermatology | 24575 Hunt Ave, Corning, CA 96021-8607 | 2019-11-14 |
| 1497399141 | Dermatology Specialists Inc | Dermatology | 4765 Carmel Mountain Rd Ste 201, San Diego, CA 92130-6657 | 2019-11-05 |
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| City | N HOLLYWOOD |
| Zip Code | 91607 |
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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.