Healthcare Provider Details

I. General information

NPI: 1205161395
Provider Name (Legal Business Name): BEACH CITIES MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2009
Last Update Date: 08/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4210 ATLANTIC AVE
LONG BEACH CA
90807-2802
US

IV. Provider business mailing address

4210 ATLANTIC AVE
LONG BEACH CA
90807-2802
US

V. Phone/Fax

Practice location:
  • Phone: 562-595-8507
  • Fax: 562-988-9220
Mailing address:
  • Phone: 562-595-8507
  • Fax: 562-988-9220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number16520 AAAHC,INC
License Number StateCA

VIII. Authorized Official

Name: NIKOLAS V CHUGAY
Title or Position: MEDICAL DIRECTOR
Credential: D.O.
Phone: 562-595-8507