MEDICARE: INDIANA FIRST MEDICAL GROUP INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	A048560	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063591584
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDIANA FIRST MEDICAL GROUP INC

Provider Business Mailing Address
First Line	:	PO BOX 63202
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90063-0202
Country	:	US
Telephone Number	:	323-268-5598
Fax Number	:	323-268-8892

Provider Business Practice Location Address
First Line	:	4082 WHITTIER BLVD STE 103
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90023-2559
Country	:	US
Telephone Number	:	323-268-5598
Fax Number	:	323-268-8892

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. PEI HSIN CHAO
Credential	:	M.D.
Telephone Number	:	323-268-5598

Provider Enumeration Date	:	11/03/2006
Last Update Date	:	06/03/2021

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Directions to “INDIANA FIRST MEDICAL GROUP INC ” Practice Location

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