Healthcare Provider Details

I. General information

NPI: 1225452048
Provider Name (Legal Business Name): BEVERLY GARDEN MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2014
Last Update Date: 11/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7916 EASTERN AVE STE 102
BELL GARDENS CA
90201-5464
US

IV. Provider business mailing address

7916 EASTERN AVE STE 102
BELL GARDENS CA
90201-5464
US

V. Phone/Fax

Practice location:
  • Phone: 562-928-7060
  • Fax: 562-928-7090
Mailing address:
  • Phone: 562-928-7060
  • Fax: 562-928-7090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number00170368
License Number StateCA

VIII. Authorized Official

Name: MR. FRED SAHAFI
Title or Position: MEDICAL DIRECTOR/ OWNER
Credential: M.D
Phone: 562-928-7060