| Olympic Orthopedic Medical Group | |
|
1224 E Avenue S Ste C Palmdale CA 93550-6180 | |
| (661) 947-0078 | |
| Not Available |
| Full Name | Olympic Orthopedic Medical Group |
|---|---|
| Speciality | Orthopaedic Surgery |
| Location | 1224 E Avenue S Ste C, Palmdale, California |
| Authorized Official Name and Position | John Kayvenfar (OWNER) |
| Authorized Official Contact | 6619470078 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Olympic Orthopedic Medical Group Po Box 260916 Encino CA 91426-0916 Ph: () - | Olympic Orthopedic Medical Group 1224 E Avenue S Ste C Palmdale CA 93550-6180 Ph: (661) 947-0078 |
| NPI Number | 1659549400 |
|---|---|
| Provider Enumeration Date | 02/14/2008 |
| Last Update Date | 07/10/2008 |
| Medicare PECOS PAC ID | 5991824534 |
|---|---|
| Medicare Enrollment ID | O20120104000077 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659549400 | NPI | - | NPPES |
| 00A368210 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | A36821 (California) | Secondary |
| 207X00000X | Orthopaedic Surgery | A36821 (California) | Primary |
| Provider Name | John J Kayvanfar |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1689743437 PECOS PAC ID: 5890609184 Enrollment ID: I20031119000716 |
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