1801073978 NPI number — ORTHOPEDIC CENTER FOR EXCELLENCE MEDICAL GROUP

Table of content: (NPI 1801073978)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801073978 NPI number — ORTHOPEDIC CENTER FOR EXCELLENCE MEDICAL GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHOPEDIC CENTER FOR EXCELLENCE MEDICAL GROUP
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:
1801073978
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21350 HAWTHORNE BLVD
Provider Second Line Business Mailing Address:
SUITE 274
Provider Business Mailing Address City Name:
TORRANCE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90503-5605
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-540-3145
Provider Business Mailing Address Fax Number:
310-540-2306

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21530 PIONEER BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAWAIIAN GARDENS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90716-2608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-540-3145
Provider Business Practice Location Address Fax Number:
310-540-2306
Provider Enumeration Date:
01/30/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HAMADA
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
SADAO
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
310-540-3145

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  207X00000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XS0117X , with the licence number: 207XS011X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1689851693 . This is a "NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: W14084A . This is a "MEDICARE GROUP PROVIDER N" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00C304700 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: W14084 . This is a "MEDICARE GROUP PROVIDER N" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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