Healthcare Provider Details

I. General information

NPI: 1467836098
Provider Name (Legal Business Name): PEDIATRIC INFECTOLOGY GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2015
Last Update Date: 07/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 ATLANTIC AVE BICKERSTAFF PEDIATRIC FAMILY CENTER
LONG BEACH CA
90806-1701
US

IV. Provider business mailing address

PO BOX 92454
LONG BEACH CA
90809-2454
US

V. Phone/Fax

Practice location:
  • Phone: 562-933-8590
  • Fax: 562-933-8093
Mailing address:
  • Phone: 562-933-8590
  • Fax: 562-933-8093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. TEMPE KATHRYN CHEN
Title or Position: PARTNER
Credential: M.D.
Phone: 310-463-6653