| South Atlantic Medical Group | |
|
1030 W Gardena Blvd Gardena CA 90247-4956 | |
| (310) 323-9999 | |
| Not Available |
| Full Name | South Atlantic Medical Group |
|---|---|
| Speciality | General Practice |
| Location | 1030 W Gardena Blvd, Gardena, California |
| Authorized Official Name and Position | Nissan Kahen (MEDICAL DIRECTOR) |
| Authorized Official Contact | 3237250167 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| South Atlantic Medical Group 5504 Whittier Blvd Los Angeles CA 90022-4104 Ph: (323) 725-0167 | South Atlantic Medical Group 1030 W Gardena Blvd Gardena CA 90247-4956 Ph: (310) 323-9999 |
| NPI Number | 1306029806 |
|---|---|
| Provider Enumeration Date | 12/07/2007 |
| Last Update Date | 12/13/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306029806 | NPI | - | NPPES |
| GR0020634 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | A41061 (California) | Primary |
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