LAKESIDE MEDICAL ASSOCIATES, A MEDICAL GROUP, INC. (NPI# 1689874596) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689874596 |
| Entity Type | Organization |
| Organization Name | LAKESIDE MEDICAL ASSOCIATES, A MEDICAL GROUP, INC. |
| Other Organization Name | LAKESIDE COMMUNITY HEALTHCARE MEDICAL GROUP |
| Practice Address |
191 S Buena Vista St Suite 150 Burbank CA 91505-4554 |
| Mailing Address |
777 Flower St Ste A Glendale CA 91201-3000 |
| Practice Telephone | 8182955920 |
| Practice Fax Number | 8182956965 |
| Mailing Telephone | 8186372000 |
| Mailing Fax Number | 8182428761 |
| Enumeration Date | 2007-07-19 |
| Last Update Date | 2009-10-27 |
| 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 | 207P00000X | Emergency Medicine | Allopathic & Osteopathic Physicians | ||
| N | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians | ||
| N | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians | ||
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | GR006838A | 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 |
| 1689869760 | Lakeside Medical Associates, A Medical Group, Inc. | Family Medicine | 12660 Riverside Dr, Suite 225, N Hollywood, CA 91607-3429 | 2007-09-11 |
| 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 |
191 S BUENA VISTA ST SUITE 150 |
| City | BURBANK |
| State | CA |
| Zip Code | 91505-4554 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134123474 | Kenneth Ballan | Internal Medicine | 191 S Buena Vista St, Ste. 215, Burbank, CA 91505-4554 | 2005-06-01 |
| 1114467255 | Ann Grosch | Audiologist-Hearing Aid Fitter | 191 S Buena Vista St, Suite 320-a, Burbank, CA 91505-4554 | 2017-03-07 |
| 1912443490 | Genesis Functional Restoration Clinic Inc | Family Medicine | 191 S Buena Vista St, 335, Burbank, CA 91505-4554 | 2017-01-09 |
| 1902342496 | Genesis Occupational Medical Clinic Inc | Family Medicine | 191 S Buena Vista St, 335, Burbank, CA 91505-4554 | 2017-01-09 |
| 1750763041 | Stetson Powell Orthopedics and Sports Medicine | Specialist | 191 S Buena Vista St, Suite 470, Burbank, CA 91505-4554 | 2015-06-23 |
| 1124407119 | Hesam Hekmatjou | Family Medicine | 191 S Buena Vista St, Suite 100, Burbank, CA 91505-4554 | 2015-05-22 |
| 1942690136 | Christopher S. Lee, Md, Mba, Inc. | Specialist | 191 S Buena Vista St, Suite 470, Burbank, CA 91505-4554 | 2015-01-27 |
| 1285036640 | Petros Hajian | Family Medicine | 191 S Buena Vista St, Suite 220, Burbank, CA 91505-4554 | 2014-09-17 |
| 1639579105 | Armine Ghazaryan Md Inc | Obstetrics & Gynecology | 191 S Buena Vista St, Suite 300, Burbank, CA 91505-4554 | 2014-09-03 |
| 1326478777 | Leslie Korostoff Md A Professional Corporation | Obstetrics & Gynecology | 191 S Buena Vista St, Suite 340, Burbank, CA 91505-4554 | 2013-11-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023625035 | K and S Hospice Inc | Hospice Care, Community Based | 4100 W Alameda Ave Fl 3, Burbank, CA 91505 | 2020-09-24 |
| 1013542471 | Jami Stehlin | Nurse Practitioner | 501 S. Buena Vista St. 3ne, Burbank, CA 91505 | 2020-03-06 |
| 1497309033 | Ibrahim Lala | Pharmacist | 181 S. Buena Vista St, Burbank, CA 91505 | 2019-08-01 |
| 1720501240 | Jung H Li | Registered Nurse | Psjmc- Bariatric Wellness Center, 501 S Buena Vista St, Burbank, CA 91505 | 2017-07-18 |
| 1699204974 | Beth Ellen Izbotsky | Physical Medicine & Rehabilitation | 501 S Buena Vista Blvd, Burbank, CA 91505 | 2017-06-08 |
| 1205387446 | Fabiola Bachman | Dentist | 138 N Pass Ave, 2, Burbank, CA 91505 | 2016-10-24 |
| 1114478203 | Marianna Ghularyan D.d.s. Inc | Dentist | 1400 N. Edison Blvd., Burbank, CA 91505 | 2016-10-24 |
| 1962952127 | Landa Mizin Dental Partnership | Dentist | 2625 W Alameda Ave Ste 502, Burbank, CA 91505 | 2016-10-11 |
| 1285183376 | Amy Di Francia | Marriage & Family Therapist | 4421 W Riverside Dr Ste 210, Burbank, CA 91505 | 2016-09-29 |
| 1306238381 | Abigail Merrin | Physical Therapist | 2701 W Alameda Ave Ste 206, Burbank, CA 91505 | 2015-02-26 |
| Find all providers in zip 91505 | ||||
| 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. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770932204 | Sam Fatoorehchi | Family Medicine | 4901 W 79th St Fl 2, Burbank, IL 60459-1569 | 2016-06-06 |
| 1750768685 | Rasha William Atallah | Family Medicine | 4901 W 79th St Ste 10, Burbank, IL 60459-1554 | 2015-04-29 |
| 1477949618 | Ciara L Shirvanian | Family Medicine | 191 S. Buena Vista Street, Suite #100, Burbank, CA 91505-4554 | 2015-04-14 |
| 1346678794 | M & C Physician Solutions PC | Family Medicine | 640 N Keystone St, Suite B, Burbank, CA 91506-1900 | 2013-10-22 |
| 1265732176 | Syeda Kulsoom Ali | Family Medicine | 4901 W 79th St Floor 2, Burbank, IL 60459 | 2010-10-26 |
| 1881915627 | Mahin Ghanevati | Family Medicine | 191 S Buena Vista St Ste 220, Burbank, CA 91505-4563 | 2010-06-16 |
| 1336467620 | Treasa L Davis | Family Medicine | 191 S Buena Vista St Ste 375, Burbank, CA 91505-4558 | 2010-05-11 |
| 1982935268 | Lynn Joseph Ramirez, M.d. Inc. | Family Medicine | 303 S Glenoaks Blvd Ste 4, Burbank, CA 91502-1193 | 2010-01-26 |
| 1538310172 | West Suburban Medical Ctr. | Family Medicine | 8333 South Austin, Burbank, IL 60459-2558 | 2008-10-01 |
| 1952560732 | Liana Poghosyan | Family Medicine | 401 S Glenoaks Blvd Ste 101, Burbank, CA 91502-2707 | 2008-06-05 |
| Find all providers in BURBANK | ||||
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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.