Healthcare Provider Details

I. General information

NPI: 1790962165
Provider Name (Legal Business Name): USC CARE MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2008
Last Update Date: 10/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 N STATE STREET A1D
LOS ANGELES CA
90033
US

IV. Provider business mailing address

PO BOX 31309
LOS ANGELES CA
90031-0309
US

V. Phone/Fax

Practice location:
  • Phone: 323-442-6018
  • Fax: 323-442-6001
Mailing address:
  • Phone: 626-457-5801
  • Fax: 626-457-5811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. MELODY CHUN
Title or Position: SECRATERY AND TRESURER
Credential:
Phone: 626-457-4145