Healthcare Provider Details

I. General information

NPI: 1225200967
Provider Name (Legal Business Name): SOUTH COAST HEALTH CARE CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2008
Last Update Date: 04/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 TERMINO AVE
LONG BEACH CA
90804-2104
US

IV. Provider business mailing address

210 N TUSTIN AVE
SANTA ANA CA
92705-3807
US

V. Phone/Fax

Practice location:
  • Phone: 562-498-1000
  • Fax:
Mailing address:
  • Phone: 714-347-1010
  • Fax: 714-647-1245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberFNP 32607
License Number StateCA

VIII. Authorized Official

Name: DR. SEYED S KAMALI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 800-883-7243