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KUSH MEDICAL GROUP NPI 1104958784


NPI Information

NPI: 1104958784
Provider Name: KUSH MEDICAL GROUP
Classification: Anesthesiology - 207LP2900X
Entity Type: Organization

Specialization: Pain Medicine

Address:
14015 VAN NESS AVE # 10
GARDENA, CA
ZIP 90249
Phone: (310) 327-7682
Get Directions

KUSH MEDICAL GROUP is a pain medicine anesthesiology in Gardena, CA. The provider is an anesthesiologist who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chronic and/or cancer pain in both hospital and ambulatory settings. Patient care needs are also coordinated with other specialists. KUSH MEDICAL GROUP NPI is 1104958784. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

14015 VAN NESS AVE # 10
GARDENA, CA
ZIP 90249-937
Phone: (310) 327-7682
Fax: (310) 327-7765

The provider's authorized official is Kiansi Boni .
The authorized official title is Owner and has the following contact phone number (310) 644-3488.

The enumeration date for this NPI number is 3/10/2007 and was last updated on 8/22/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207LP2900XAnesthesiologyPain MedicineA45536CALIFORNIAYes
2207Q00000XFamily MedicineA45536CALIFORNIAX
3208000000XPediatricsA45536CALIFORNIAX
4208VP0014XPain MedicineInterventional Pain MedicineA45536CALIFORNIAX

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
100A455361MEDICAIDCALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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