Healthcare Provider Details

I. General information

NPI: 1043316730
Provider Name (Legal Business Name): ORTHOPEDIC CENTER FOR EXCELLENCE MEDICAL GROUP A MEDICAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 01/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21500 PIONEER BLVD SUITE 208
HAWAIIAN GARDENS CA
90716-2600
US

IV. Provider business mailing address

21500 PIONEER BLVD SUITE 208
HAWAIIAN GARDENS CA
90716-2600
US

V. Phone/Fax

Practice location:
  • Phone: 310-540-3145
  • Fax: 310-540-2306
Mailing address:
  • Phone: 310-540-3145
  • Fax: 310-540-2306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberC30470
License Number StateCA

VIII. Authorized Official

Name: JAMES SADAO HAMADA
Title or Position: PRESIDENT
Credential: MD
Phone: 310-540-3145