Healthcare Provider Details

I. General information

NPI: 1831470947
Provider Name (Legal Business Name): SWEIDAN, SOHL & EMAMIAN MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2011
Last Update Date: 10/09/2024
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1022 LONG BEACH BLVD
LONG BEACH CA
90813-3221
US

IV. Provider business mailing address

PO BOX 8500
NEWPORT BEACH CA
92658-8500
US

V. Phone/Fax

Practice location:
  • Phone: 562-513-3135
  • Fax: 562-513-3189
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JACOB SWEIDAN
Title or Position: PRESIDENT/CEO/OWNER
Credential: M.D.
Phone: 714-915-4656