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PACIFIC SHORES MEDICAL GROUP INC NPI 1598814634


NPI Information

NPI: 1598814634
Provider Name: PACIFIC SHORES MEDICAL GROUP, INC
Classification: Internal Medicine - 207RH0003X
Entity Type: Organization

Specialization: Hematology & Oncology

CLIA Number: 05D1021933

Address:
19582 BEACH BLVD
STE 212
HUNTINGTON BEACH, CA
ZIP 92648
Phone: (714) 252-9415
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PACIFIC SHORES MEDICAL GROUP, INC is a hematology and oncology internal medicine in Huntington Beach, CA. The provider is an internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered. PACIFIC SHORES MEDICAL GROUP, INC NPI is 1598814634. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

19582 BEACH BLVD
STE 212
HUNTINGTON BEACH, CA
ZIP 92648-996
Phone: (714) 252-9415

The provider's authorized official is Nerses Simon Tchekmedyian .
The authorized official title is Ceo and has the following contact phone number (562) 590-0345.

The CLIA number assigned to this NPI record is 05D1021933 - physician office with a certificate type of Certificate of Accreditation.

The enumeration date for this NPI number is 1/9/2007 and was last updated on 4/12/2016.


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
1207RH0003XInternal MedicineHematology & OncologyYes

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
1W13494CMEDICARE PINCALIFORNIA
2GR0065542MEDICAIDCALIFORNIA
31118450002MEDICARE NSCCALIFORNIA

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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