Provider Demographics
NPI:1609754183
Name:FORWARD UROLOGY MEDICAL GROUP APC
Entity type:Organization
Organization Name:FORWARD UROLOGY MEDICAL GROUP APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NATARAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANDRASEKHAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-760-2800
Mailing Address - Street 1:12922 VICTORY BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-2924
Mailing Address - Country:US
Mailing Address - Phone:818-760-2800
Mailing Address - Fax:818-760-7343
Practice Address - Street 1:2625 W ALAMEDA AVE STE 400
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4817
Practice Address - Country:US
Practice Address - Phone:818-841-6055
Practice Address - Fax:818-841-1082
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FORWARD UROLOGY MEDICAL GROUP APC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-08-23
Last Update Date:2025-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty