| Advanced Lung Center Medical Group Inc. | |
|
401 S La Brea Ave Ste 205 Inglewood CA 90301-2321 | |
| (310) 275-7575 | |
| Not Available |
| Full Name | Advanced Lung Center Medical Group Inc. |
|---|---|
| Speciality | Internal Medicine |
| Location | 401 S La Brea Ave Ste 205, Inglewood, California |
| Authorized Official Name and Position | Jamshid Niknam (PRESIDENT) |
| Authorized Official Contact | 3102757575 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Advanced Lung Center Medical Group Inc. 401 S La Brea Ave Ste 205 Inglewood CA 90301-2321 Ph: (310) 275-7575 | Advanced Lung Center Medical Group Inc. 401 S La Brea Ave Ste 205 Inglewood CA 90301-2321 Ph: (310) 275-7575 |
| NPI Number | 1164593323 |
|---|---|
| Provider Enumeration Date | 11/10/2006 |
| Last Update Date | 04/22/2014 |
| Medicare PECOS PAC ID | 4082508197 |
|---|---|
| Medicare Enrollment ID | O20040210000876 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164593323 | NPI | - | NPPES |
| 00A520810 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | A52081 (California) | Secondary |
| 207RP1001X | Internal Medicine - Pulmonary Disease | A52081 (California) | Primary |
| Provider Name | Jamshid Niknam |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1134132798 PECOS PAC ID: 9032003157 Enrollment ID: I20050210000201 |
| Provider Name | Hossein Babaali |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1699790584 PECOS PAC ID: 0547206559 Enrollment ID: I20050629001235 |
| Provider Name | Kane John Dominguez Cua |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538562145 PECOS PAC ID: 7113213893 Enrollment ID: I20161220002484 |
| Provider Name | Josh Kwan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285145995 PECOS PAC ID: 0941569776 Enrollment ID: I20180124000105 |
| Provider Name | Daniel N Niknam |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1598262073 PECOS PAC ID: 5597161869 Enrollment ID: I20210913000680 |
| Provider Name | Monica Cruz Araneta |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093450876 PECOS PAC ID: 0547649618 Enrollment ID: I20220620001786 |
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