Healthcare Provider Details

I. General information

NPI: 1326271313
Provider Name (Legal Business Name): SJ MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2009
Last Update Date: 08/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S HOBART BLVD STE 301
LOS ANGELES CA
90020-3693
US

IV. Provider business mailing address

300 S HOBART BLVD STE 301
LOS ANGELES CA
90020-3693
US

V. Phone/Fax

Practice location:
  • Phone: 213-385-9090
  • Fax:
Mailing address:
  • Phone: 213-385-9090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JENNIFER J BAIK
Title or Position: SECRETARY
Credential: M.D.
Phone: 213-385-9090