Healthcare Provider Details

I. General information

NPI: 1730255548
Provider Name (Legal Business Name): SO PASADENA OB & GYN MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CONGRESS ST STE 403
PASADENA CA
91105-3023
US

IV. Provider business mailing address

10 CONGRESS ST STE 403
PASADENA CA
91105-3023
US

V. Phone/Fax

Practice location:
  • Phone: 626-577-8058
  • Fax: 626-440-9976
Mailing address:
  • Phone: 626-577-8058
  • Fax: 626-440-9976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License NumberG40118
License Number StateCA

VIII. Authorized Official

Name: DR. JOSEPH Y LI
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 626-577-8058