NPI 1114193182

South Atlantic Medical Group Ipa

Organisation Exclusive Provider Organization Los Angeles, CA

Practice location

Address: 5504 Whittier Blvd, Los Angeles, CA 90022-4104
Phone: (323) 725-0167

Authorised official

Name: Nissan Kahen
Title: Medical Director
Phone: (323) 725-0167

Registered specialties

Exclusive Provider Organization Primary

Managed Care Organizations Taxonomy 302F00000X Licence A410610 (CA)

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Registry record

NPI: 1114193182
Entity type: Organization
NPI issued: 30 Apr 2008
Record last updated: 30 Apr 2008

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.