Healthcare Provider Details

I. General information

NPI: 1710077961
Provider Name (Legal Business Name): L AND P MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 05/29/2020
Certification Date: 05/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 S ALVARADO ST STE 102
LOS ANGELES CA
90006-4161
US

IV. Provider business mailing address

1107 S ALVARADO ST STE 102
LOS ANGELES CA
90006-4161
US

V. Phone/Fax

Practice location:
  • Phone: 213-380-9999
  • Fax: 213-380-7904
Mailing address:
  • Phone: 213-380-9999
  • Fax: 213-380-7904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: LOGHMAN ABDIAN
Title or Position: MD
Credential: MD
Phone: 213-380-9999