SOUTH ATLANTIC MEDICAL GROUP NPI 1629251541

NPI Information

NPI: 1629251541
Provider Name: SOUTH ATLANTIC MEDICAL GROUP
Classification: General Practice - 208D00000X
Entity Type: Organization
Address:
2616 CLARENDON AVE
HUNTINGTON PARK, CA
ZIP 90255
Phone: (323) 589-6633
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SOUTH ATLANTIC MEDICAL GROUP is a general practice in Huntington Park, CA. SOUTH ATLANTIC MEDICAL GROUP NPI is 1629251541. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

2616 CLARENDON AVE
HUNTINGTON PARK, CA
ZIP 90255-120
Phone: (323) 589-6633

The provider's authorized official is Nissan Kahen .
The authorized official title is Medical Director and has the following contact phone number (323) 725-0167.

The enumeration date for this NPI number is 12/13/2007 and was last updated on 12/13/2007.

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 Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	208D00000X	General Practice		A41061	CALIFORNIA	Yes

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 Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	GR0020632	MEDICAID	CALIFORNIA

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: 11/14/2023

NPI Synchronization or Removal

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