MEDICARE: MAJESTIC MEDICAL CLINIC, 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	A62993	CA

General Provider Information

NPI Number	:	1083079289
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAJESTIC MEDICAL CLINIC, INC.

Provider Business Mailing Address
First Line	:	817 ATLANTIC AVE # 14
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90813-4512
Country	:	US
Telephone Number	:	562-453-5236
Fax Number	:

Provider Business Practice Location Address
First Line	:	817 ATLANTIC AVE # 14
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90813-4512
Country	:	US
Telephone Number	:	562-453-5236
Fax Number	:

Authorized Official
Title or Position	:	OWNER/MEDICAL DIRECTOR
Name	:	DR. CHRISTINA DARY LEE
Credential	:	M.D.
Telephone Number	:	562-453-5236

Provider Enumeration Date	:	12/15/2015
Last Update Date	:	12/15/2015

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