Healthcare Provider Details

I. General information

NPI: 1639475312
Provider Name (Legal Business Name): SOUTHERN CALIFORNIA MEDICAL COALITION INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2011
Last Update Date: 01/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 AIRPORT PLAZA DR STE 150
LONG BEACH CA
90815-1275
US

IV. Provider business mailing address

5000 AIRPORT PLAZA DR STE 150
LONG BEACH CA
90815-1275
US

V. Phone/Fax

Practice location:
  • Phone: 562-766-2000
  • Fax: 562-766-2008
Mailing address:
  • Phone: 562-766-2000
  • Fax: 562-766-2008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID KIM
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MD
Phone: 562-766-2000