MEDICARE: SPECIALTY CARE PAIN 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	207LP2900X	Pain Medicine (Anesthesiology) Physician
2	208VP0014X	Interventional Pain Medicine Physician

General Provider Information

NPI Number	:	1700555364
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECIALTY CARE PAIN MEDICAL GROUP INC

Provider Business Mailing Address
First Line	:	1653 7TH ST UNIT 7548
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90406-8012
Country	:	US
Telephone Number	:	310-564-6139
Fax Number	:	626-609-4195

Provider Business Practice Location Address
First Line	:	11500 W OLYMPIC BLVD STE 502
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-1528
Country	:	US
Telephone Number	:	310-985-1779
Fax Number	:	626-609-4195

Authorized Official
Title or Position	:	MD/OWNER
Name	:	DR. BRIAN LAI
Credential	:	MD
Telephone Number	:	310-985-1779

Provider Enumeration Date	:	09/08/2021
Last Update Date	:	01/03/2023

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Directions to “SPECIALTY CARE PAIN MEDICAL GROUP INC ” Practice Location

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