1316224025 NPI number — CLIFFORD SEGIL DO A MEDICAL CORPORATION

Table of content: AARON STEPHEN WANG MD (NPI 1154981041)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316224025 NPI number — CLIFFORD SEGIL DO A MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLIFFORD SEGIL DO A MEDICAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316224025
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2001 SANTA MONICA BLVD
Provider Second Line Business Mailing Address:
SUITE 1170
Provider Business Mailing Address City Name:
SANTA MONICA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90404-2102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-828-8838
Provider Business Mailing Address Fax Number:
310-828-2099

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2001 SANTA MONICA BLVD
Provider Second Line Business Practice Location Address:
SUITE 1170
Provider Business Practice Location Address City Name:
SANTA MONICA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90404-2102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-828-8838
Provider Business Practice Location Address Fax Number:
310-828-2099
Provider Enumeration Date:
11/08/2011

Additional Information

Authorized Official

Authorized Official Last Name:
SEGIL
Authorized Official First Name:
CLIFFORD
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
310-829-3611

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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