MEDICARE: CRENSHAW FAMILY 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	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1700819448
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRENSHAW FAMILY MEDICAL CENTER, INC

Provider Business Mailing Address
First Line	:	4249 1/2 CRENSHAW BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90008-2536
Country	:	US
Telephone Number	:	323-299-7508
Fax Number	:

Provider Business Practice Location Address
First Line	:	4249 1/2 CRENSHAW BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90008-2536
Country	:	US
Telephone Number	:	323-299-7508
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MONE SANDHU
Credential	:	M.D.
Telephone Number	:	323-299-7508

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	08/22/2020

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