MEDICARE: SILICON BEACH MEDICAL CENTER 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	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1366964330
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SILICON BEACH MEDICAL CENTER INC

Provider Business Mailing Address
First Line	:	4712 ADMIRALTY WAY # 574
Second Line	:
City	:	MARINA DEL REY
State	:	CA
Zip	:	90292-6905
Country	:	US
Telephone Number	:	310-305-9200
Fax Number	:	310-305-2800

Provider Business Practice Location Address
First Line	:	5450 LINCOLN BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90094-2002
Country	:	US
Telephone Number	:	310-305-9200
Fax Number	:	310-305-2800

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	YOUNG SUN YI
Credential	:	MD
Telephone Number	:	310-305-9200

Provider Enumeration Date	:	07/12/2017
Last Update Date	:	12/01/2020

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