MEDICARE: IN PAIN PHYSICIANS NETWORK INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207L00000X	Anesthesiology Physician
2	207LP2900X	Pain Medicine (Anesthesiology) Physician
3	208VP0000X	Pain Medicine Physician
4	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1720730500
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IN PAIN PHYSICIANS NETWORK INC

Provider Business Mailing Address
First Line	:	PO BOX 3129
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90510-3129
Country	:	US
Telephone Number	:	310-792-3914
Fax Number	:	855-898-4055

Provider Business Practice Location Address
First Line	:	200 W WARDLOW RD
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-4429
Country	:	US
Telephone Number	:	310-448-3459
Fax Number	:	310-388-3259

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DANIEL PHILIP LODER
Credential	:
Telephone Number	:	310-448-3459

Provider Enumeration Date	:	01/22/2022
Last Update Date	:	01/22/2022

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