Healthcare Provider Details

I. General information

NPI: 1104550623
Provider Name (Legal Business Name): THOMAS GEORGE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2022
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 S GRAND AVE
LOS ANGELES CA
90015-3010
US

IV. Provider business mailing address

3333 S LA CIENEGA BLVD APT 6032
LOS ANGELES CA
90016-4372
US

V. Phone/Fax

Practice location:
  • Phone: 213-748-2411
  • Fax:
Mailing address:
  • Phone: 650-353-6182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number20A24770
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: