MEDICARE: LIVE OAK MEDICAL 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	207R00000X	Internal Medicine Physician	A50735	CA

General Provider Information

NPI Number	:	1750387379
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIVE OAK MEDICAL INC

Provider Business Mailing Address
First Line	:	20 E HUNTINGTON DR
Second Line	:
City	:	ARCADIA
State	:	CA
Zip	:	91006-3209
Country	:	US
Telephone Number	:	626-447-8000
Fax Number	:	626-447-8002

Provider Business Practice Location Address
First Line	:	20 E HUNTINGTON DR
Second Line	:
City	:	ARCADIA
State	:	CA
Zip	:	91006-3209
Country	:	US
Telephone Number	:	626-447-8000
Fax Number	:	626-447-8002

Authorized Official
Title or Position	:	CFO
Name	:	JEFFREY WANG
Credential	:
Telephone Number	:	626-447-8000

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	08/23/2013

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