| Kerry R Clark, MD | |
|
25751 Mcbean Pkwy, Ste 210, Valencia, CA 91355-3701 | |
| (661) 284-3100 | |
| (661) 290-3310 |
| Full Name | Kerry R Clark |
|---|---|
| Gender | Male |
| Speciality | Internal Medicine |
| Location | 25751 Mcbean Pkwy, Valencia, California |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093802365 | NPI | - | NPPES |
| 00G771370 | Other | CA | BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | G60150 (California) | Primary |
| Entity Name | Northeast Valley Health Corporation |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1629079009 PECOS PAC ID: 3173517323 Enrollment ID: O20040412001067 |
| Mailing Address | Practice Location Address |
|---|---|
| Kerry R Clark, MD 23388 Mulholland Dr, Mailstop 62, Woodland Hills, CA 91364-2733 Ph: (818) 876-1636 | Kerry R Clark, MD 25751 Mcbean Pkwy, Ste 210, Valencia, CA 91355-3701 Ph: (661) 284-3100 |
Mostafa Tabassomi, MD Internal Medicine Medicare: Accepting Medicare Assignments Practice Location: 23838 Valencia Blvd Ste 304, Valencia, CA 91355 Phone: 661-430-9030 Fax: 661-430-9020 | |
Dr. Gene L Tran, D.O. Internal Medicine Medicare: Accepting Medicare Assignments Practice Location: 23803 Mcbean Pkwy, Valencia, CA 91355 Phone: 661-481-2400 | |
Dr. Robert Kozlowski, MD Internal Medicine Medicare: Accepting Medicare Assignments Practice Location: 25751 Mcbean Pkwy Ste 210, Valencia, CA 91355 Phone: 661-284-3100 Fax: 661-290-3310 | |
Dr. Douglas R Gadowski, MD Internal Medicine Medicare: Accepting Medicare Assignments Practice Location: 25775 Mcbean Pkwy, Ste 105, Valencia, CA 91355 Phone: 661-255-2410 Fax: 661-255-8671 | |
Sittiporn Bencharit, M.D. Internal Medicine Medicare: Medicare Enrolled Practice Location: 25775 Mcbean Pkwy, Suite 115, Valencia, CA 91355 Phone: 661-255-2420 Fax: 661-259-0552 | |
David Elliott Krieger, M.D.,PH.D. Internal Medicine Medicare: Not Enrolled in Medicare Practice Location: 25775 Mcbean Pkwy, Suite 115, Valencia, CA 91355 Phone: 661-255-2420 Fax: 661-259-5741 | |
Brian Nan Peng, Internal Medicine Medicare: Medicare Enrolled Practice Location: 25775 Mcbean Pkwy Ste 202, Valencia, CA 91355 Phone: 661-753-5464 Fax: 661-753-5466 |