Healthcare Provider Details

I. General information

NPI: 1053230870
Provider Name (Legal Business Name): SCLC NORTH PC A MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12665 GARDEN GROVE BLVD STE 304
GARDEN GROVE CA
92843-1917
US

IV. Provider business mailing address

8447 WILSHIRE BLVD
BEVERLY HILLS CA
90211-3226
US

V. Phone/Fax

Practice location:
  • Phone: 310-553-5203
  • Fax:
Mailing address:
  • Phone: 310-553-5203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License Number
License Number State

VIII. Authorized Official

Name: GLENN ANDREW MARSHAK
Title or Position: OWNER
Credential: MD
Phone: 310-553-5203