| Sunmoon Urgent Care Medical Group Inc | |
|
1161 1/2 Logan St Los Angeles CA 90026-3210 | |
| (213) 484-1289 | |
| (213) 484-2339 |
| Full Name | Sunmoon Urgent Care Medical Group Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1161 1/2 Logan St, Los Angeles, California |
| Authorized Official Name and Position | Xia Li (MD) |
| Authorized Official Contact | 2134841289 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sunmoon Urgent Care Medical Group Inc Po Box 573 Monterey Park CA 91754-0573 Ph: () - | Sunmoon Urgent Care Medical Group Inc 1161 1/2 Logan St Los Angeles CA 90026-3210 Ph: (213) 484-1289 |
| NPI Number | 1144316217 |
|---|---|
| Provider Enumeration Date | 10/05/2006 |
| Last Update Date | 10/22/2014 |
| Medicare PECOS PAC ID | 3476525536 |
|---|---|
| Medicare Enrollment ID | O20040809001443 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144316217 | NPI | - | NPPES |
| 00A845840 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | W17844 (California) | Primary |
| Provider Name | Xia Li |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1659467728 PECOS PAC ID: 1658343710 Enrollment ID: I20040810000652 |
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