Healthcare Provider Details

I. General information

NPI: 1316940828
Provider Name (Legal Business Name): GOOD LIFE MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650 SOUTH ST STE 204
LAKEWOOD CA
90712-1521
US

IV. Provider business mailing address

3650 SOUTH ST STE 204
LAKEWOOD CA
90712-1521
US

V. Phone/Fax

Practice location:
  • Phone: 562-602-8841
  • Fax: 562-602-8843
Mailing address:
  • Phone: 562-602-8841
  • Fax: 562-602-8843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A6005
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA050818
License Number StateCA

VIII. Authorized Official

Name: DR. PETER HUGH
Title or Position: C.E.O.
Credential: D.O.
Phone: 562-602-8841