Healthcare Provider Details

I. General information

NPI: 1801049697
Provider Name (Legal Business Name): LOS ANGELES EAR MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2008
Last Update Date: 10/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 W DUARTE RD SUITE 105
ARCADIA CA
91007-7606
US

IV. Provider business mailing address

622 W DUARTE RD SUITE 105
ARCADIA CA
91007-7606
US

V. Phone/Fax

Practice location:
  • Phone: 626-574-6921
  • Fax: 626-574-9604
Mailing address:
  • Phone: 626-574-6921
  • Fax: 626-574-9604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License NumberG52831
License Number StateCA

VIII. Authorized Official

Name: LUCY SHIH
Title or Position: PHYSICIAN/ OWNER
Credential: M.D.
Phone: 626-574-6921